恶性神经胶质瘤脑膜脊髓播散转移15例临床病例分析

目的：通过分析 15 例发生脑膜脊髓播散转移的脑胶质瘤患者的临床表现，对其特点进行归纳总结。方法：回顾性分析首都医科大学附属北京世纪坛医院脑胶质瘤科 2011 年1 月至 2015 年9 月收治 15 例发生脑膜脊髓播散转移的脑胶质瘤患者，其中 WHOⅡ级5 例，Ⅲ级6 例，Ⅳ级4 例；原发于脑干 1 例，原发于脊髓 2 例，原发于幕上 12 例。15 例患者中行活检术 1 例，近全切除 4 例，完全切除10 例。结果：患者出现的症状包括：腰背疼痛、浅感觉异常、肢体感觉和运动功能障碍、二便失禁、癫痫发作等。出现脑膜脊髓播散的中位时间为 10 （1.5～80 ）个月。发生脑膜脊髓播散后患者接受的治疗手段包括：全身化疗，全脊柱放疗，椎管内鞘注化疗，靶向治疗。15 例患者的中位生存期为 20 （9～83 ）个月，自发生脑膜、脊髓播散至死亡的中位生存期为 6（2～48 ）个月。结论：恶性神经胶质瘤患者发生脑膜脊髓播散转移后生存期短，预后不佳，选择合适的患者进行放疗、化疗及鞘内注射化疗等多种治疗方法可使某些患者生存获益。

Clinical characteristics of 15 glioma cases with leptomeninges and spinal cord metastases

Objective:To retrospectively analyze and summarize the clinical characteristics of 15 glioma cases that led to leptomenin-ges and spinal cord metastases in Department of Glioma, Beijing Shijitan Hospital, Capital Medical University since 2011. Methods:A total of 15 cases were considered, including 5 patients with World Health Organization gradeⅡ, 6 patients with gradeⅢ, and 4 pa-tients with gradeⅣ. One patient had a tumor at the brain stem, two patients had tumors at the spinal cords, and the other patients had tumors at the hemispheres. One case received biopsy, 4 cases received subtotal resection, and 10 cases received complete resec-tion. Results: Symptoms included low back pain, sensory and motor dysfunction, incontinence, and seizures. After the metastases spread to the cerebrospinal region, patients were treated with chemotherapy, whole spine radiotherapy, intrathecal chemotherapy, and target therapy. The median time of leptomeninges and spinal cord metastasis dissemination appearance was 10 months (1.5-80 months) since surgery. The median overall survival time of the 15 patients was 20 months (9-83 months), and the median survival time was 6 months (2-48 months) after leptomeninges and spinal cord metastases. Conclusion:The prognosis of glioma patients with lepto-meninges and spinal cord metastases was poor, and a proportion of the patients who received appropriate treatment might have a better survival.