松果体区肿瘤所致脑积水的分类处理  

Classified treatment of hydrocephalus induced by pineal region tumor

作　　者：方陆雄[1] 徐书翔[1] 张辉[1] 樊俊[1] 漆松涛[1] 

机构地区：[1]南方医科大学南方医院神经外科,广州510515

出　　处：《中国微侵袭神经外科杂志》2015年第3期105-107,共3页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的探讨松果体区肿瘤所致脑积水的处理方法。方法回顾性分析143例并发脑积水的松果体区肿瘤病人的临床资料,依据肿瘤的组织学类型和处理方法进行分类,然后比较不同的病理类型、不同的治疗方式之间脑积水缓解率及半年复发率的差异。行肿瘤放疗或化疗39例,脑室-腹腔分流后放疗1例,神经内镜下第三脑室底造瘘后放疗1例,第三脑室底造瘘+神经内镜下活检后化疗2例、放疗1例,开放性肿瘤切除术56例,开放性肿瘤切除术+术中直视下第三脑室底造瘘术43例。6例肿瘤切除术前先行化疗。结果仅行肿瘤切除术的病人,术后脑积水治疗有效率87.5%,半年内复发8例。肿瘤切除术中辅以第三脑室底造瘘的病人,脑积水治疗有效率100%,复发2例。在各种病理类型的肿瘤中,胶质瘤术后脑积水缓解率最低,复发率最高。生殖细胞瘤直接放疗或化疗后脑积水均缓解,且无复发。结论松果体区肿瘤所致脑积水的治疗结果与肿瘤病理类型和治疗方式相关。肿瘤切除术中辅以直视下第三脑室底造瘘术可明显提高脑积水的治疗效果。Objective To explore the reasonable treatment of hydrocephalus induced by pineal region tumors. Methods Clinical data of 143 pineal region tumors patients with hydrocephalus were analyzed retrospectively. The patients were classified according to the pathological type and treatment respectively, and the differences in remission rate and 6-month relapse rate among different pathological types and treatments were compared. Simple tumor radiotherapy or chemotherapy was performed on 39 patients, radiotherapy after ventricular peritoneal shunt on 1, radiotherapy after endoscopic third ventriculostomy on 1, chemotherapy and radiotherapy after third ventriculostomy and endoscopic biopsy on 2 and 1 respectively, open tumor resection on 56, open tumor resection and third ventriculostomy during surgery on 43. Six patients received radiotherapy before tumor resection. Results The postoperative effective rate of hydrocephalus was 87.5% and 8 reoccurred after 6 months in patients who only received tumor resection. The postoperative effective rate of hydrocephalus was 100% and 2 reoccurred in patients who received tumor resection and third ventriculostomy. In all pathological types, glioma was associated with the lowest postoperative remission rate of hydrocephalus and the highest relapse rate. Hydrocephalus was ameliorated after direct radiotherapy or chemotherapy in all patients with germinoma and no relapse occurred. Conclusions The therapeutic outcome of hydrocephalus induced by pineal region tumors was associated with the pathological type of tumor and the treatment method. Tumor resection combined with intmoperative third ventriculostomy can improve the therapeutic efficacy of hydrocephalus.

关 键 词：脑肿瘤 松果体区 脑积水 神经内镜 第三脑室底造瘘 化疗 放疗 

分 类 号：R739.41[医药卫生—肿瘤] R651.1[医药卫生—临床医学]