颅内孤立性纤维性肿瘤的显微手术治疗分析  

Microsurgical treatment of intracranial solitary fibrous tumors:report of 31 cases

作　　者：全威 胡均贤[3] 安再尔·艾合买提 杨桂芳[2] 陈劲草[1] 张捷[1] 李志强[1] QUAN Wei;HU Jun-xian;ANZAIER Aihemaiti;YANG Gui-fang;CHEN Jin-cao;ZHANG Jie;LI Zhi-qiang(Department of Neurosurgery,Zhongnan Hospital of Wuhan University,Wuhan 430071,China;Department of Pathology,Zhongnan Hospital of Wuhan University,Wuhan 430071,China;Department of Neurosurgery,Huanggang Central Hospital,Huanggang 438000,China)

机构地区：[1]武汉大学中南医院神经外科,武汉430071 [2]武汉大学中南医院病理科,武汉430071 [3]黄冈市中心医院神经外科,湖北438000

出　　处：《中国临床神经外科杂志》2024年第3期129-134,共6页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨颅内孤立性纤维性肿瘤的临床特点、影像学特征、病理学特征、显微手术方法及其疗效。方法回顾性分析2014年8月至2023年7月手术治疗并经术后病理证实的31例颅内孤立性纤维性肿瘤的临床资料。结果31例中,男17例,女14例;年龄16~65岁;初次手术17例,再次手术14例;临床表现以头晕、头痛等非特异性症状为主;影像学表现为边界多清晰,MRI呈稍低T1信号、高T2信号,T2FLAIR大多高信号,近半数(14例,45.2%)可见明显瘤周水肿;MRI T1增强表现为明显均匀强化18例(58.1%),不均匀及环形强化12例(38.7%)。25例(80.6%)肿瘤全切除,6例(19.3%)行次全切除。术后病理检查显示肿瘤特征性表达STAT6(100.0%,31/31),不同程度表达CD34(93.5%,29/31)、Vimentin(64.5%,20/31)及Bcl-2(25.8%,8/31);Ki-67阳性率2%~30%,平均(11±7)%,Ki-67阳性率随肿瘤病理级别升高而升高。失访9例,成功随访22例,随访时间6~80个月,平均(35.0±23.8)个月;死亡3例,其余19例存活。结论颅内孤立性纤维性肿瘤瘤周水肿常见,可呈不均匀强化或环形强化,确诊依靠病理检查。肿瘤易复发,可能全身转移,早期诊断、尽早行手术有助于改善病人的预后。Objective To investigate the clinical features,imaging characteristics,pathological features,and microsurgical techniques and outcomes of intracranial solitary fibrous tumors(SFTs).Methods The clinical data of 31 patients with intracranial SFTs who underwent microsurgery from August 2014 to July 2023 were retrospectively analyzed.Results Of these 31 patients with intracranial SFTs,17 were male and 14 were female;the age ranged from 16 to 65 years;17 patients underwent the first surgery,and 14 underwent the secondary surgery;the clinical manifestations were mainly non-specific symptoms such as dizziness and headache;most SFTs had the imaging characteristics of well-defined borders,slightly low T1 signals,high T2 signals,and high T2 FLAIR signals;14 cases(45.2%)showed obvious peritumoral edema;the contrast-enhanced MR T1 iamges showed uniform enhancement in 18 cases(58.1%)and nonuniform and ring-like enhancement in 12 cases(38.7%).Total resection of tumor was achieved in 25 patients(80.6%)and subtotal in 6(19.3%).Postoperative pathological examination showed that positive expression of STAT6 was found in all 31 patients(100%),positive CD34 in 29 patients(93.5%),positive Vimentin in 20 patients(64.5%),and positive Bcl-2 in 8 patients(25.8%);the Ki-67 positive rate ranged from 2%to 30%,with a mean of(11±7)%,and the positive rate increased with the increase of tumor pathological grade.Nine patients were lost to follow-up,and 22 patients were successfully followed up for 6~80 months,with a mean of(35.0±23.8)months;three patients died,and the remaining 19 patients were alive.Conclusions Peritumoral edema is common in intracranial STFs,and the tumors may show non-uniform enhancement or ring-like enhancement on contrast-enhanced MR T1 images.Pathological examination is necessary for the diagnosis of SFTs.SFTs are prone to recurrence and may spread throughout the body.Early diagnosis and surgery at an early stage can help improve the prognosis of the patients with intracranial SFTs.

关 键 词：颅内孤立性纤维性肿瘤 血管外皮细胞瘤 显微手术 疗效 

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