原发性视交叉恶性胶质瘤1例并文献回顾  

Primary Chiasmatic Malignant Glioma:A Case Report and Literature Review

作　　者：冯睿[1] 张明广[1] 孙兵[1] 刘晓东[1] 程海霞[2] 车晓明[1] 

机构地区：[1]复旦大学附属华山医院神经外科,200040 [2]复旦大学附属华山医院神经病理室,200040

出　　处：《中国临床神经科学》2011年第2期168-171,182,共5页Chinese Journal of Clinical Neurosciences

摘　　要：目的:了解原发性视交叉恶性胶质瘤的疾病特点。方法:对收治的1例以无诱因出现视力下降为首发症状,并经手术病理确诊的原发性视交叉恶性胶质瘤患者予以回顾性分析,并结合文献复习分析该病特点。结果:患者影像学检查CT平扫示鞍上视交叉区有一等密度、形状不规则的2.5cm×1.2cm×2cm病灶。MRI平扫见视交叉明显增大,形态可辨,双侧视神经不对称增粗,T1相呈等或低信号,T2相呈稍高信号;增强后见视交叉内有一体积约1.1cm×1cm×1.2cm强化灶,伴有多处囊变坏死,增粗的双侧视神经内亦有异常强化灶,无明显边界。手术治疗经右侧改良翼点入路,术中见肿瘤主体位于视交叉,色灰红,间有黄色组织,血供丰富。肿瘤尽量切除,大脑前动脉、垂体柄保护完好。术后患者双眼视力无改善。1个月后复查增强MRI,见残余肿瘤进一步生长。于术后3个月后病死于当地医院。结论:结合文献复习表明,原发性视交叉恶性胶质瘤十分罕见,主要见于成人,目前仅4例见于文献,恶性程度很高,预后极差。手术切除是首选治疗方法,但不易全切,术后后续放疗和化疗可延长患者生存期。Aim：To discuss the feature of primary chiasmatic malignant glioma.Methods：The case of a visually defected patient who was diagnosed,with primary chiasmatic malignant glioma was analyzed,and in the mean time,the literature were reviewed to summerize the characteristic of such disease.Results：CT shows a suprasellar lesion to be iso-intense and irregularly shaped,the volume is measured around 2.5 cm×1.2 cm×2 cm.MR shows the chiasm to be enlarged obviously,and the shape of it can be recognized.Bilateral optic nerves were enlarged asymmetrically.The chiasm shows iso- or hypo-intensity on T1 and slight hyperintensity on T2.With contrast,a lesion with cystic change measured about 1.1 cm×1 cm×1.2 cm emerges apparently. There are also abnormal enhancement inside bilateral optic nerves without discernable border to normal tissue. The surgery was performed by modified pterional approach.The tumor body was located inside the chiasm, the colour was grey red mixed up with yellow tissue,the blood supply was abundant.Subtotal removal of the tumor was performed,the surrounding structure such as bilateral ACAs and pituitary stalk were preserved well.The patient showed no visual improvement after surgery.1 month later the MR showed further invasion of the tumor,then the patient died in local hospital 3 months later after the operation.Conclusion：Accordeing to the literature there were only 4 cases of primary chiasmatic malignant gliomas（PCMGs） reported in English literature.Patients diagnosed with such disease usually showed quite poor prognosis.The treatment is surgical removal of the tumor,but the operation should not be aggressive.Post-operative radiotherapy and chemotherapy may be helpful to extend the survival time of patients.

关 键 词：恶性视路胶质瘤 原发性视交叉恶性胶质瘤 外科治疗 

分 类 号：R730.264[医药卫生—肿瘤]