松果体区占位的治疗策略和疗效分析(附55例报告)  

Analysis of treatment strategies and efficacy of pineal region lesions(a report of 55 cases)

作　　者：杨陈 宋照明 顾靖宇 陈周青 王中[1] Yang Chen;Song Zhaoming;Gu Jingyu;Chen Zhouqing;Wang Zhong(Department of Neurosurgery,the First Affiliated Hospital of Soochow University,Suzhou 215006,Jiangsu,China)

机构地区：[1]苏州大学附属第一医院神经外科,江苏苏州215006

出　　处：《中国微侵袭神经外科杂志》2024年第10期579-585,共7页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的 探讨松果体区占位的治疗策略及预后。方法 回顾性分析55例松果体区占位患者的临床资料,其中采用显微外科治疗42例,放化疗治疗3例,保守治疗10例,并进行跟踪随访与预后评价。结果 在42例手术病人中,全切除40例(95.2%),次全切除2例(4.8%)。非手术治疗13例,未见肿瘤或囊肿增大。病理证实良性肿瘤19例,其中脑膜瘤15例,脂肪瘤2例,松果体囊肿2例;恶性肿瘤23例,其中松果体实质肿瘤9例,生殖细胞肿瘤8例,胶质瘤3例,非典型脑膜瘤1例,原始神经外胚层肿瘤1例,孤立性纤维性肿瘤/血管周细胞瘤1例。其余占位根据影像学表现、脑脊液及血清肿瘤标志物检查判断,脂肪瘤1例,松果体细胞瘤2例,生殖细胞瘤2例,松果体囊肿8例。1例患者因并发症致病情恶化而死亡,54例患者随访1个月~10年,1年生存率90.1%,3年生存率89.7%,5年生存率85.7%。结论 对于松果体区占位,良性肿瘤显微外科治疗效果好,恶性肿瘤经显微外科治疗辅以术后放化疗亦可改善预后。生殖细胞肿瘤对放射治疗敏感,放疗应为首选。对于松果体区肿瘤,显微外科治疗是治愈的最佳方式,选择合适手术入路是手术成功的关键。Objective To explore the treatment strategy and prognosis of pineal region occupancy.Methods The clinical data of 55 patients with pineal region lesions were analyzed retrospectively.Among them,42 were treated with microsurgery,3 were treated with radiotherapy and chemotherapy,and 10 were treated conservatively.Follow-up was performed to evaluate the prognosis.Results Among the 42 operated patients,40(95.2%)underwent total resection and 2(4.8%)received subtotal resection.Thirteen cases were treated non-surgically,and no tumor or cyst enlargement was observed.Pathological examination confirmed benign tumors were seen in 19 cases,including 15 meningiomas,2 lipomas,and 2 pineal cyst;malignant tumors were 23 cases,including 9 pineal parenchymal tumors,8 germ cell tumors,3 gliomas,1 atypical meningioma,1 primitive neuroectodermal tumor,and 1 solitary fibrous tumor/hemangiopericytoma.The remaining lesions were diagnosed based on imaging findings,cerebrospinal fluid,and serum tumor marker tests,including 1 lipoma,2 pineocytomas,2 germ cell tumors,and 8 pineal cysts.One patient died due to complications resulting in deterioration of the condition,54 patients were followed up for 1 month to 10 years,with a 1-year survival rate of 90.1%,a 3-year survival rate of 89.7%and a 5-year survival rate of 85.7%.Conclusions For pineal region masses,microsurgery has a good effect on benign tumors,and microsurgery combined with postoperative radiation therapy and chemotherapy can also improve the prognosis of malignant tumors.Germ cell tumors are sensitive to radiotherapy,and radiotherapy should be the first choice.For pineal region tumors,microsurgery is the best way to cure them,and choosing the right surgical approach is the key to successful surgery.

关 键 词：脑肿瘤 松果体区占位 显微外科治疗 放射疗法 化学疗法 

分 类 号：R739.41[医药卫生—肿瘤]