丘脑胶质瘤的多模态影像立体定向活检及同期侧脑室-腹腔分流术  

Multimodal imaging guided stereotactic biopsy and simultaneous ventriculoperitoneal shunt for thalamic gliomas

作　　者：钱若兵 魏祥品 牛朝诗 吴旻 王林 凌士营 计颖 傅先明 汪业汉 

机构地区：[1]安徽医科大学附属省立医院神经外科、安徽省脑立体定向神经外科研究所、脑功能与脑疾病安徽省重点实验室,合肥230001

出　　处：《中华神经医学杂志》2014年第5期504-507,共4页Chinese Journal of Neuromedicine

基　　金：国家自然科学基金（81172407）;安徽省科技攻关项目（11010402165）;安徽省重点实验室绩效考核项目（1306c083028）

摘　　要：目的 探讨丘脑胶质瘤患者行多模态影像立体定向活检术以及同期在立体定向引导下行双侧脑室-腹腔分流术的手术方法及优点. 方法 安徽医科大学附属省立医院神经外科自2008年4月至2013年9月治疗丘脑胶质瘤患者37例,其中15例患者行立体定向活检＋同期侧脑室-腹腔分流术,22例仅行立体定向活检术.回顾性分析患者的临床资料和疗效. 结果 37例患者术中冰冻及术后常规病理报告均为胶质瘤,行双侧脑室-腹腔分流术的15例患者脑积水症状明显缓解,术后及放疗后未出现脑积水症状加重;另22例患者随着肿瘤增大或放疗后水肿,出现不同程度的脑积水症状.单纯立体定向活检组患者2年生存率为31.3％,立体定向活检＋同期侧脑室-腹腔分流术组患者2年生存率为69.2％,比较差异有统计学意义（P＜0.05）. 结论 对于局限于丘脑或主体大部分位于丘脑的胶质瘤,通过多模态影像立体定向多靶点活检术可以明确诊断;而同期在立体定向引导下将脑室分流管准确置入侧脑室前角行脑室-腹腔分流术,可以缓解脑积水症状并显著延长生存期.Objective To investigate the operation strategy and advantages of multimodal imaging guided stereotactic biopsy and simultaneous ventriculoperitoneal shunt for thalamic gliomas.Methods Thirty-seven patients with thalamic gliomas,admitted to our hospital from April 2008 to September 2013,were chosen in our study; 15 of them were performed multimodal imaging guided stereotactic biopsy and simultaneous ventriculoperitoneal shunt and 22 were only performed stereotactic biopsy; their clinical data and clinical efficacy were compared.Results All patients were confirmed as having gliomas by intraoperative frozen section and postoperative regular pathologic results.Hydrocephalus was significantly relieved in the patients underwent stereotactic ventriculoperitoneal shunt,without aggravation after operation or radiotherapy.However,the other 22 patients without ventriculoperitoneal shunt developed different degrees of hydrocephalus due to tumor enlarging or edema after radiotherapy.Cumulative relative survival （CRS） over 2 years of the simple biopsy group and the biopsy plus simultaneous ventriculoperitoneal shunt group was 31.3% and 69.2%,respectively,with statistically significant difference （P〈0.05）.Conclusions Multimodal imaging guided stereotactic multiple targets biopsy can make a definite diagnosis ofgliomas located （or its main body） in thalamus.When being combined with stereotactic ventriculoperitoneal shunt accurately via bilateral anterior horn of lateral ventricle,relief of hydrocephalus and prolong postoperative median survival time can be achieved.

关 键 词：丘脑 神经胶质瘤 立体定向 活检术 脑室-腹腔分流术 

分 类 号：R739.41[医药卫生—肿瘤]