儿童囊性毛细胞型星形细胞瘤的治疗

目的 总结儿童囊性毛细胞型星形细胞瘤的临床特点和治疗经验。方法 回顾性分析过去5年间我科收治的20例儿童囊性毛细胞型星形细胞瘤的临床资料。本组20例，占同期住院胶质瘤的6．0％，发病年龄平均为9岁。病变在小脑者14例，下视丘/视路2例，三脑室内2例，大脑半球内2例。20例患儿均接受显微手术治疗。肿瘤位于小脑幕者采用下正中入路；肿瘤位于下视丘／视路者采用翼点入路；三脑室内肿瘤选择胼胝体-透明隔入路，颞叶肿瘤均采用额颞瓣开颅。肿瘤全切除18例。2例术后有残余者接受放射治疗。照射剂量30～40Gy。无手术死亡。结果 术后1周内行影像学检查以证实切除程度。20例在术后24h行头颅CT检查，12例在术后4～6周行MRI检查做为以后MRI检查的对比基础。18例随访半年以上无复发。结论 儿童囊性毛细胞型星形细胞瘤为良性肿瘤，预后较好，显微手术切除和恰当的放疗是治疗的关键。

Therapeutic experience of cystic pilocytic astrocytoma in children

Objective To summarize the clinical characteristics and therapeutic experience of cystic pilocytic astrocytoma in children. Methods The clinical data of 20 children with cystic pilocytic astrocytoma treated in this Department in the last 5 years were analyzed retrospectively. In this series, cystic pilocytic astrocytoma accounted for 6.0% of all intracranial glioma. The mean age was 9.0 yrs old. The tumors were found in the cerebellum in 14 cases, the hypothalamus/visual pathway in 2, the third ventricle in 2 and the cerebral hemisphere in 2 respectively. Microsurgical resection was performed in all 20 cases. The inferior tentorium approach was adopted for cerebellum lesion (14 cases), pterion approach for hypothalamus/visual pathway (2 cases), callosum Pellucidum approach for the third ventricle (2 cases), frontal temporal approach for 2 temporal lobe tumors. The tumors in 18 cases were totally removed. The remaining 2 cases with residual tumor tissue were treated with radiotherapy after surgery. Results An imaging study was performed within one week postoperatively. All the 20 patients received the cranial CT scanning 24 hrs after surgery to detect the extent of tumor resection, and 12 of them had MRI examination. The postoperative follow up at the 6th month showed no recurrence of their intracranial tumor. Conclusions Cystic pilocytic astrocytoma in children is a benign intracranial tumor with good prognosis. The microsurgical resection in combination with proper postoperative radiotherapy seems to be a good treatment of choice for this disease.