显微手术治疗中枢神经系统血管母细胞瘤的临床疗效  

Clinical effect of microsurgical treatment of hemangioblastomas in the central nervous system

作　　者：周广平 邹杨鸿 张志婷 耿鑫[1] 黄文强 刘涛[1] 杨鸿宇 李经辉[1] Zhou Guangping;Zou Yanghong;Zhang Zhiting;Geng Xin;Huang Wenqiang;Liu Tao;Yang Hongyu;Li Jinghui(Department of Neurosurgery,the First Affiliated Hospital of Kunming Medical University,Kunming 650032,China)

机构地区：[1]昆明医科大学第一附属医院神经外科,650032

出　　处：《中华神经外科杂志》2021年第2期133-137,共5页Chinese Journal of Neurosurgery

基　　金：云南省卫健委医学后备人才培养计划基金(H-201639);云南省高层次卫生健康技术人才培养经费资助项目(H-2018054)。

摘　　要：目的观察显微手术治疗中枢神经系统血管母细胞瘤(HB)的临床疗效。方法回顾性分析昆明医科大学第一附属医院神经外科2016年1月至2020年1月采用显微手术治疗的41例HB患者的临床资料。其中3例合并Von Hippel-Lindau(VHL)综合征。肿瘤切除术前,2例行脑室-腹腔分流术,1例行第三脑室底脚间池造瘘术,3例行部分供血动脉栓塞术。术中患者均行冲经电生理监测,2例联合应用术中B超与术前MRI融合技术,2例辅助神经内镜技术。术后3个月采用Karnofsky功能状态评分(KPS)评估临床疗效,影像学观察肿瘤复发情况。结果41例患者中,肿瘤全切除40例(97.6%),部分切除1例(2.4%)。术后1例(2.4%)患者死于颅内感染,2例(4.9%)出现严重的肺部感染。术后3个月随访,40例患者中,症状改善者30例(75.0%),较术前尤明显变化者10例(25.0%);KPS为(79.8±15.3)分,与术前的(70.2±14.9)分比较,差异有统计学意义(P=0.011)。MRI检查显示4例(10.0%)出现原位复发或远隔部位新发病灶,其中3例为合并VHL的患者;4例均给予放射治疗,随访MRI证实肿瘤均缩小。结论在多种技术联合下,中枢神经系统的手术全切除率高、并发症的发生率低。合并VHL综合征者术后肿瘤可能更易复发。Objective To explore the clinical effect of mic rosurgical treatment of hemangioblastoma(HB)in the central nervous system.Methods The clinical data of 41 HB patients who underwent microsurgery from January 2016 to January 2020 at Department of Neurosurgery,the First Affiliated Hospital of Kunming Medical University were retrospectively analyzed.Three of them were complicated with Von Hippel-Lindau(VHL)syndrome.Before tumor resection,2 cases underwent ventricular-abdominal shunting;1 case underwent third ventriculostomy connecting the third ventricle with the interpeduncular cistern;3 cases undenvent partial embolization of the blood supply artery.Intraoperative neuroelectrophysiological monitoring was performed in all patients.Intraoperative real-time ultrasound with preoperative MRI fusion technology;was used in 2 rases,and auxiliary neuroendoscopy was employed in 2 cases.The Karnofsky neurological function score(KPS)was used to evaluate the clinical efficacy at 3 months post operation,and the tumor recurrence was followed up by imaging.Results Among 41 patients,total resection of tumor was achieved in 40 cases(97.6%)and partial resection in 1 case(2.4%).One patient(2.4%)died of intracranial infeclion after surgery,and two patients(4.9%)developed severe lung infection.At 3-month follow-up,30 out of 40 patients(75.0%)had symptomatic improvement,and 10 patients(25.0%)had no significant changes in symptoms compared with preoperative conditions.The KPS score was 79.8±15.3 points,which had significant difference from preopemtive score(70.2±14.9 points)(P=0.011).MRI examination showd that 4 cases(10.0%)had recurrence in the original location or new lesions in distant regions,of which 3 cases were patients with VHL and underwent radiation treat men l resulting in tumor shrinkage on follow-up MKI.Conclusions With the1 combination of multiple techniques,the total resection rate of HB in the central nervous system seems high with low incidence of complications.HB patients with VHL syndrome may have a higgler chance of t

关 键 词：血管母细胞瘤 中枢神经系统 显微外科手术 治疗结果 

分 类 号：R739.4[医药卫生—肿瘤]