局灶性脑干胶质瘤的临床特点及显微手术治疗  

Clinical features and microsurgical management of focal brainstem gliomas

作　　者：张申起[1] 彭彬[1] 陈治标[1] 田道锋[1] 王军民[1] 刘宝辉[1] 杨吉安[1] 陈谦学[1] 

机构地区：[1]武汉大学人民医院神经外科,武汉430060

出　　处：《中国临床神经外科杂志》2017年第9期609-612,共4页Chinese Journal of Clinical Neurosurgery

基　　金：湖北省自然科学基金(ZRMS2016001156)

摘　　要：目的探讨局灶性脑干胶质瘤的临床表现及显微手术治疗方法。方法回顾性分析2011年1月至2017年1月在功能MRI、术中神经电生理监测及神经导航辅助下显微手术治疗的25例局灶性脑干胶质瘤的临床资料。病灶位于桥脑的16例中,采用枕下乙状窦后入路13例,枕下后正中入路3例;病灶位于延髓的2例采用枕下后正中入路;病灶位于中脑的7例采用颞下入路。结果肿瘤近全切除19例,部分切除6例。术后16例神经功能障碍较术前好转,4例无明显变化,5例出现新的神经功能损害。术后病理检查结果均为星形细胞瘤,其中WHOⅠ~Ⅱ级15例,Ⅲ~Ⅳ级10例。出院时按GOS评分评估预后,预后良好(GOS评分4~5分)19例,差(2~3分)5例,死亡(1分)1例。20例术后随访3个月至1年,平均6个月;3例死亡,2例复发,余15例未见肿瘤有明显进展。结论在功能MRI、术中神经电生理监测及神经导航辅助下显微手术治疗局灶性脑干胶质瘤,有助于提高手术安全性、降低术后并发症,并能最大限度的切除脑干胶质瘤,改善病人神经功能障碍。Objective To investigate the clinical features and microsurgical treatment of focal brainstem gliomas.MethodsTheclinical data of 25 patients with focal brainstem gliomas who underwent microsurgery assisted by functional MRI, intraoperativeneurophysiological monitoring and neurological navigation from January 2011 to January 2017 were retrospectively analyzed. Of 16 patients with tumors locating in the pons, 13 patients underwent operation via suboccipital retrosigmoid approach and 3 via mediansuboccipital approach. Two patients with tumors locating in the medulla oblongata underwent operation via median suboccipitalapproach. Seven patients with tumors locating in the midbrain underwent operation via subtemporal approach.ResultsTotal resection ofthe tumors was achieved in 19 patients, and partial in 6. The neurological dysfunction was improved in 16 patients, no change in 4, andworsened in 5 after operation. Postoperative pathological findings showed astrocytomas in all the patients, including WHO grade Ⅰ~Ⅱin 15 cases and grade Ⅲ~Ⅳ in 10. Nineteen patients had good prognosis(GOS score of 4 to 5 points), 5 had poor prognosis(GOS scoresof 2 to 3 points) and 1 died on discharge from hospital. Of 20 patients who were followed up from 3 months to 1 year with a mean time of6 months, 3 patients died, 2 had recurrence of the tumors and 15 had no progress of the tumors.ConclusionThe curative effect ofmicrosurgery for focal brainstem gliomas is good. The functional MRI, intraoperative neurophysiological monitoring and neurologicalnavigation can help improve the safety of operation, reduce postoperative complications, maximize the removal of tumors, and improvethe prognosis.

关 键 词：局灶性脑干胶质瘤 临床特点 神经电生理监测 神经导航 显微手术 

分 类 号：R739.41[医药卫生—肿瘤] R651.11[医药卫生—临床医学]