脑胶质瘤切除术后脑脊髓内播散转移:3例报道及国内文献复习

背景与目的:随着神经外科诊断和治疗技术的提高,原发灶局部的脑胶质瘤在一定程度上得以很好的控制,这样临床上发现脑胶质瘤术后脑、脊髓内播散转移的病例就多了起来,但针对这方面的临床研究目前还很少。本文通过分析脑胶质瘤切除术后发生脑、脊髓内播散病例的特性及其规律性,探讨其综合的治疗方法。方法:回顾性分析我院的3例以及国内各家医院报道的16例脑胶质瘤患者,19例患者均行实体肿瘤切除术。18例患者术后常规行外放射治疗,其中5例同时行化学治疗,2例行!-刀治疗。19例患者经上述综合治疗后发生了脑脊髓播散、转移。结果:原发脑胶质瘤部位:大脑半球9例(47.4%),小脑6例(31.6%),脑室系统4例(21.0%)。病理类型:星形细胞瘤12例(63.2%),髓母细胞瘤4例(21.0%),室管膜瘤2例(10.5%),胶质母细胞瘤1例(5.3%)。术后播散时间12天至5年,平均20.0个月。播散部位:脊髓12例(63.2%),对侧大脑半球4例(21.0%),脑干与间脑2例(10.5%),第三、四脑室2例(10.5%),胼胝体2例(10.5%)。12例再次行手术全部或大部切除病变,术后患者2年生存率是33%(4/12),6例采取非手...

Clinical Experience of Spinal and Intracranial Dissemination of Glioma after Surgery:3-case Report and Review of the Literature

BACKGROUND & OBJECTIVE:Recent advances in neurosurgical diagnosis and intervention allow better local control for glioma. There is a growing number of glioma patients experiencing intracranial and/or spinal dissemination. However, there was few literature reporting on this condition. The purpose of this study is to analyze the behaviour of intracranial and spinal dissemination of glioma after surgical resection. METHODS: Nineteen patients from several hospitals in China were retrospectively analyzed. The data of clinical record, histopathology and imaging were collected. RESULTS:There were 9 intracerebral glioma (47.4%), including 6 located at frontal lobe, 2 at parietooccipital lobe and 1 at temporal lobe. There were 6 cerebellar glioma(31.6%). There were 4(21.0%)ventricular tumor, including 3 at fourth ventricle and 1 at lateral ventricle. There were 12(63.2%)astrocytoma, 4(21.0%) medulloblastoma, 2(10.5%)ependymocytoma, 1(5.3%) glioblastoma. The postoperative dissemination time was from 12 days to 5 years, with the mean time of 20 months. Spine cord invasion was found in 12(63.2%)cases. There were 4 contralateral cerebral spread(21.0%), 2 brain stem and diencephalons spread(10.5%),2 ventricular system spread(10.5%) and 2 callosal spread. There was one case of extensive spread involving ventricular system, intramedulla, apophysis area, contralateral temporal and splenium of corpus callosum. CONCLUSIONS:The incidence of dissemination with primary astrocytoma was higher than medulloblastoma. Adjuvant radiotherapy should be given after surgical excision of glioma. Focal radiation, ie gamma knife, should not be considered.