立体定向活检术在儿童弥漫内生型脑桥胶质瘤诊断中的应用  

Stereotactic biopsy in the diagnosis of pediatric diffuse intrinsic pontine gliomas

作　　者：王登元 白茫茫[1] 张剑宁[2] 张雷鸣[2] 杨帆[2] 吴昊泽 WANG Dengyuan;BAI Mangmang;ZHANG Jianning;ZHANG Leiming;YANG Fan;WU Haoze(Department of Neurosurgery, Affiliated Hospital of Yan＇ an University, Yan＇ an 716000;Department of Neurosurgery,Naval General Hospital, Beijing 100048, China)

机构地区：[1]延安大学附属医院神经外科,陕西延安716000 [2]海军总医院神经外科,北京100048

出　　处：《中华神经外科疾病研究杂志》2018年第3期207-211,共5页Chinese Journal of Neurosurgical Disease Research

摘　　要：目的探讨立体定向活检术在儿童弥漫内生型脑桥胶质瘤诊断中的临床价值、手术方法、技术要点及降低手术并发症的方法。方法回顾性分析2015年1月至2017年12月期间北京海军总医院行立体定向弥漫内生型脑桥胶质瘤活检患儿34例,其中男17例,女17例,年龄2~16岁(平均6.6岁),其中常规框架立体定向引导活检13例,无框架机器人辅助立体定向引导活检21例。结果32例患儿获得明确病理诊断,2例未明确病理诊断,活检阳性率94.1%(32例),其中低级别胶质瘤1例,弥漫型星形细胞瘤(WHOⅡ级)16例,间变型星形细胞瘤(WHOⅢ级)10例,原始神经外胚层肿瘤(primitive neuroectodermal tumor,PNET)1例,间变型少突星形细胞瘤(WHOⅢ级)1例,胶质瘤(WHOⅡ~Ⅲ级)1例,节细胞瘤(WHOⅠ级)1例,胶质母细胞瘤(WHOⅣ级)1例。手术相关并发症4例(11.8%),其中术区出血2例,暂时性神经功能障碍2例,无永久性神经功能障碍,无手术相关死亡。结论立体定向儿童脑干肿瘤活检安全、可靠,具有较高诊断率,组织病理学及分子生物学特征的明确可为儿童脑干胶质瘤患者个体化治疗及相关分子靶向治疗提供新思路。Objective The clinical value of stereotactic biopsy in the diagnosis of pediatric diffuse intrinsic pontine gliomas （DIPG）,the operation methods,technical points and clinical experiences of reducing the surgical complications were investigated.Methods A retrospective study was performed based on thirty-four children who underwent stereotactic biopsy for DIPG,at Beijing Naval General Hospital,from January 2015 to December 2017.The patients comprised 17 males and 17 females,aged from 2 to 16 years （average 6.6 years）,who underwent biopsy via either frame-guided （thirteen children） or robot-assisted （twenty-one children） stereotaxis.Results A final histopathological diagnosis was made in thirty-two children with two non-diagnostic cases,with 94.1％ for diagnostic yield.Low-grade glioma was diagnosed in 1 case,diffuse astrocytoma （WHO Ⅱ） in 16,anaplastic astrocytoma （WHO Ⅲ） in 10,glioma （WHO Ⅱ～ Ⅲ） in 1,gangliocytoma （WHO Ⅰ） in 1,anaplastic oligodendrocytoma in 1,primitive neuroectodermal tumor （PNET） and glioblastoma （WHO Ⅳ） were diagnosed in 1 patient respectively.Surgery related with complications occurred in 4 patients （11.8 ％）,2 with bleeding in the biopsied area,and 2 with temporary neurological deficits,with no permanent neurological deficits and mortality.Conclusion Stereotactic biopsy for DIPG on pediatric patients allows for a high diagnostic yield,safety and reliability.The identification of histopathology and molecular biology features can pave the new way for individual treatment concepts and the targeted therapy of DIPG.

关 键 词：立体定向 儿童弥漫内生型脑桥胶质瘤 活检术 靶向治疗 

分 类 号：R651.11[医药卫生—外科学]