脑干神经节细胞胶质瘤的临床特征及外科治疗  

Clinical features and microsurgical treatment of braiustem gangliogliomas

作　　者：陈新[1] 泮长存[1] 王宇[1] 武文浩[1] 张鹏[1] 徐骋[1] 吴涛[1] 吴震[1] 张俊廷[1] 张力伟[1] 

机构地区：[1]首都医科大学附属北京天坛医院神经外科,100050

出　　处：《中华神经外科杂志》2017年第5期436-441,共6页Chinese Journal of Neurosurgery

基　　金：国家“十二五”科技支撑计划（2014BA104B01）;国家“十三五”科技支撑计划（2015BA112B04）;北京市自然科学基金（7161004）;北京市医院管理局重点医学专业发展计划（ZYLX201608）

摘　　要：目的探讨脑干神经节细胞胶质瘤的临床及影像学特征、手术策略和预后。方法回顾性分析2008年5月至2015年9月首都医科大学附属北京天坛医院神经外科手术治疗的25例脑干神经节细胞胶质瘤患者的临床资料，总结临床特征、影像学特点和手术策略及预后。结果25例患者的中位年龄为22．0岁（5～45岁），中位病程为12．0个月（1—384个月），术前Karnofsky功能状态评分（KPS）为20—100分。17例（68％）肿瘤MRI矢状位强化呈特征性“斑片样”，11例（44％）肿瘤轴位强化呈“新月征”。25例患者中7例肿瘤全切除、5例次全切除、8例大部切除、4例部分切除和1例活检，无手术相关死亡的患者。随访时间为3～97个月，平均（50．5±27．7）个月。随访中3例出现严重并发症，死亡3例。非浸润脑干组的中位无进展生存期（5例，53．0个月）长于浸润脑干组（20例，21．5个月）（P〈0．05）。8例术后短期出现肿瘤复发但不伴临床症状加重。结论多数脑干神经节细胞胶质瘤具有独特的影像学特点。治疗首选手术切除，脑干外肿瘤应尽量全切除，浸润脑干内部的肿瘤不应勉强切除。术后短期不伴临床症状恶化的肿瘤复发应密切观察。Objective To analyze the clinical and imaging features, microsurgical strategy and prognosis of hrainstem gangliogliomas. Methods We retrospectively analyzed a cohort of 25 brainstem gangliogliomas treated at Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from May 2008 to September 2015. The clinical manifestation, imaging features, microsurgical methods and prognosis were reviewed. Results The median age of 25 patients was 22 （ range ： 5 - 45 ） years, median history was 12 （range： 1 -384） months and the preoperative Karnofsky Performace Status （KPS） scores ranged from 20 to 100. On the enhanced sagittal MRI, 17 （68%） tumors were characterized by a unique patchy appearance. On the enhanced axial MRI, 11 tumors （44%） demonstrated a ＂crescent sign＂. Among all patients, total resection was achieved in 7 cases, near total resection in 5 cases, subtotal resection in 8 cases, partial resection in 4 cases and biopsy in 1 case. No operative death occurred. The follow-up time ranged from 3 to 97 months, with an average follow-up of （50.5 ＋ 27.7） months. There were 3 cases developing severe postoperative complications and 3 death cases observed during the follow-up. The median PFS of non-infiltrating group （53.0 months） was longer than that of infiltrating group （21.5 months） （P 〈 0.05 ）. Tumor recurrence occurred in 8 cases in a short period of time postoperatively but did not present with symptom aggravation. Conclusions Most brainstern gangliogliomas seem to have some unique MRI characteristics. Microsurgical resection might be preferred. Tumors located outside the brainstem could be fully removed, while those infiltrating the brainstem should not be resected with risks. Postoperative shortterm tumor recurrence without clinical symptom deterioration could be closely monitored.

关 键 词：脑干肿瘤 神经节神经胶质瘤 症状和体征 显微外科手术 预后 

分 类 号：R739.41[医药卫生—肿瘤]