西藏自治区脑结核瘤手术治疗分析（附16例报道并文献复习）

目的 总结西藏自治区脑结核瘤的诊治经验。方法 回顾性分析西藏自治区人民医院2013年9月至2021年9月手术治疗的16例脑结核瘤的临床资料。结果 15例为脑内单发病灶行开颅显微镜下手术切除病灶；1例多发病灶，手术切除小脑蚓部较大病灶以及左侧丘脑较小病灶。术后均给予标准抗结核治疗2个月，停用吡嗪酰胺，其它3联化疗3个月～1年。16例术后病理检查均诊断为脑结核瘤。1例小脑半球较大病灶术后并发严重肺部感染、电解质紊乱，最终死亡；其余15例术后随访1年，改良Rankin量表评分0分，未见复发。结论 西藏地区结核病高发，对颅内占位性病变，需重视与脑结核瘤鉴别。部分具有手术指征的脑结核瘤，积极手术治疗，联合术后规范抗结核治疗，疗效满意。

Surgical treatment of cerebral tuberculomas in the Tibet Autonomous Region (report of 16 cases and literature review)

Objective To summarize the experience in diagnosis and treatment of cerebral tuberculomas in the Tibet Autonomous Region. Methods The clinical data of 16 patients with cerebral tuberculomas treated by operation in The People's Hospital of Tibet Autonomous Region from September 2013 to September 2021 were retrospectively analyzed. Results Fifteen patients with single lesions underwent craniotomy under a microscope, and 1 patient had multiple lesions whose larger lesion in the vermis of the cerebellum and the smaller lesion in the left thalamus were removed. Pyrazinamide was stopped in all patients who were given standard anti-tuberculosis therapy for 2 months, and the other 3 combined chemotherapy lasted for 3 months to 1 year. All patients were diagnosed with cerebral tuberculoma by postoperative pathological examination. The follow-up (1 year) showed a modified Rankin scale score of 0 in 15 patients without recurrence, and death in 1 patient with large cerebellar hemisphere lesions due to complicated with severe pulmonary infection and electrolyte disturbance after surgery. Conclusions There is a high incidence of tuberculosis in the Tibet Autonomous Region. Attention should be paid to the differentiation of intracranial space-occupying lesions from the cerebral tuberculoma. For the cerebral tuberculomas with surgical indications, surgical treatment combined with postoperative standard anti-tuberculous treatment can obtain good outcomes.