成人丘脑肿瘤的临床特点及显微手术治疗

目的探讨丘脑肿瘤的临床特点及显微外科治疗。方法总结48例丘脑肿瘤的临床特点。对其中35例分别采用侧脑室前角入路、侧脑室后部和三角区人路、颞后皮质人路及经胼胝体侧脑室入路手术切除肿瘤，5例行脑室一腹腔分流术，1例行外减压术，余7例拒绝手术。41例手术病人术后除1例海绵状血管瘤病人外，40例行放疗，总剂量40～50Gy。结果35例选择显微手术切除的病人中肿瘤全切25例（71．4％）。近全切7例（20．0％），大部分切除2例（5．7％），部分切除1例（2，8％）。肿瘤切除术后短期症状和神经功能明显改善10例（28．6％）。改善12例（34．3％），无变化10例（28．6％），恶化2例（5，7％），死亡1例（2．8％）。结论丘脑肿瘤以儿童及青年人发病为主。性别差异不明显，病程相对较长，多为恶性肿瘤，部分病例进展较快。临床表现以颅高压及丘脑局限性损害症状为主。丘脑肿瘤治疗首选手术切除．术后应辅以必要的放疗和化疗。

Clinical features and microsurgical treatment of thalamic tumors in adults

Objective To probe into the clinical features and microsurgical therapy of thalamic tumors. Methods The clinical features of 48 adult thalamic tumors were summarized. Tumors were resected in 35 cases via transcortical transventricular approach, transcortical transtemporal approach, and transcallosal approach. Vetriculoperitoneal (V-P) shunt was done in 5 cases, and cerebral decompression in 1. The rest 7 patients refused the surgery. Of the 41 patients with surgery, except 1 of cavernous hemangioma, 40 accepted radiotherapy with the total doses of 40-50 Gy. Results Total resection of the tumor was achieved in 25 cases (71.4%), subtotal in 7 (20.0%), most in 2 (5.7%), and partial in 1 (2.8%). Postoperative clear improvement was achieved in 10 cases (28.6%), improvement in 12 (34.3%), unchange in 10 (28.6%), aggravation in 2 (5.7%), and death in 1 (2.8%). Conclusion Thalamic tumors can occur in all ages, but have a preponderance of children and adolescents. The male to female ratio is almost equal. Most of the tumors are malignant. The disease course is relatively long, but some patients have a rapid evolution. The clinical picture is dominated by manifestations of raised intracranial pressure and focal sensory and motor deficits. The first strategy for treating thalamic tumor is resection of the tumor, with adjuvant radiotherapy and chemotherapy.