胼胝体胶质瘤显微外科治疗及预后  

Microsurgery and prognosis of glioma in the corpus callosum

作　　者：程传东 彭楠[1] 计颖 程伟[1] 夏养华 钱中润 Cheng Chuandong;Peng Nan;Ji Ying;Cheng Wei;Xia Yanghua;Qian Zhongrun(Department of Neurosurgery,The First Affiliated Hospital of University of Science and Technology of China,Hefei,Anhui 230001,China)

机构地区：[1]中国科学技术大学附属第一医院神经外科,安徽合肥230001

出　　处：《中国微侵袭神经外科杂志》2024年第3期138-143,共6页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的探讨胼胝体胶质瘤显微外科手术疗效及预后相关因素。方法回顾性分析50例胼胝体胶质瘤病例资料,肿瘤位于胼胝体前部42例,体部1例,压部7例。均行显微手术切除,其中6例采用术前导航联合术中MRI辅助肿瘤切除术。胶质母细胞瘤42例,少突胶质细胞瘤4例,弥漫星形细胞瘤3例,室管膜瘤1例。结果根据术后1个月功能状态评分标准(Karnofsky,KPS评分)将病人分为预后较好组(KPS评分≥70分)26例,预后较差组(KPS评分<70分)24例。在单因素分析中,病人生存期、病变有无累及内囊、术中有无左侧皮质破坏及肿瘤是否全切,两组差异具有统计学意义(均P<0.05)。多因素Logistic回归模型分析发现:病人术后KPS评分与损伤累及内囊、术中破坏左侧皮质有关(均P<0.05)。结论对于部分胼胝体胶质瘤病人显微手术切除肿瘤能够提高病人术后KPS评分,使病人受益。术前应制定合理的手术方案,避免左侧皮质损伤,术中保护内囊回流静脉及大脑前动脉,避免脑室过多开放。对于肿瘤累及下视丘及第三脑室病人,可考虑仅行部分肿瘤切除以降低颅内压。Objective To explore the efficacy and prognostic factors of microsurgery for glioma in the corpus callosum.Methods The clinical data of 50 patients with glioma in corpus callosum were retrospectively analyzed,and the tumors were located in the anterior part of the corpus callosum in 42,body in 1 patient,and splenium in 7.All the patients underwent microsurgical resection,and 6 of them received preoperative navigation combined with intraoperative MRI-assisted tumor resection.There were 42 cases of glioblastoma,4 of oligodendroglioma,3 of diffuse astrocytoma,and 1 case of ependymoma.Results According to the Karnofsky performance scale score(KPS score)1 month after operation,the patients were divided into two groups:the better prognosis group(KPS score≥70 points)with 26 cases and the poor prognosis group(KPS score<70 points)with 24.In univariate analysis,there were statistically significant differences in patient survival,lesion involvement of internal capsule,left cortical destruction during surgery,and total tumor resection(all P<0.05).Multivariate logistic regression model analysis showed that the postoperative KPS score was related to the involvement of the internal capsule and the destruction of the left cortex during surgery(all P<0.05).Conclusions For some patients with glioma in the corpus callosum,microsurgical resection of the tumor can improve the postoperative KPS score of the patient,which can benefit the patient.A reasonable surgical plan should be formulated before surgery to avoid left cortical injury,protect the internal capsular return vein and anterior cerebral artery,and avoid excessive opening of the ventricles.In the patients with tumor involvement in the hypothalamus and third ventricle,partial resection of the tumor may be considered to reduce intracranial pressure.

关 键 词：神经胶质瘤 胼胝体 KPS评分 预后 

分 类 号：R739.41[医药卫生—肿瘤] R730.2[医药卫生—临床医学]