颅内视通路多发节细胞胶质瘤癫疒间的手术治疗
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摘要
目的总结颅内视通路多发节细胞胶质瘤癫疒间的诊治经验。方法回顾性分析2例以癫疒间发作为首发症状的颅内视通路多发节细胞胶质瘤病例资料。MRI均显示左侧视通路(视交叉、视束、外侧膝状体)多发性病灶。术前评估为左侧颞叶癫疒间,均在术中唤醒下实施裁剪式左侧前颞叶(含杏仁核、海马)切除,同时切除部分视通路病变,其中1例术中部分切除视交叉病变。结果术后病人视野缺损均不同程度加重。术后病理报告为颞叶局灶性皮质发育不良,海马硬化,节细胞胶质瘤。术后癫疒间控制分别达到Engel分级Ⅱa级和Ⅰa级。结论节细胞胶质瘤属良性神经元胶质细胞混合性肿瘤(WHOⅠ级),最常见症状为癫疒间发作。视通路节细胞胶质瘤极罕见,颞叶癫疒间+视通路多发病灶是特征性临床表现。手术治疗应以控制癫疒间发作为主要目的,无需过多切除非致疒间性的肿瘤灶而加重视觉功能缺失。
Objective To summarize the experience of diagnosis and treatment for multifocal gangliogliomas with epilepsy in the optic pathway. Methods Clinical data of 2 patients with multifocal gangliogliomas in the optic pathway, whose first symptom was epilepsy,were analyzed retrospectively. Multi-lesions along the left optic pathway were showed on the MRI including optic chiasm, tract and lateral geniculate body. Left temporal lobe epilepsy was diagnosed by preoperative evaluation. The patients received left temporal lobe tailored resection(including the amygdale and hippocampus) and partial lesion excision(including optic chiasma in 1 case) under awake anesthetic condition. Results The postoperative optic field defects worsened to different degrees. Ganglioglioma as the lesion and focal cortical dysplasia of the temporal lobe were confirmed by pathologic examination. According to Engel classification, the seizure control achieved grade Ⅱa or Ⅰa in the two patients during postoperative follow up. Conclusions Ganglioglioma is a benign neuronal-glial cell mixed tumor(WHO I). The most common symptom is seizure. Gangliogliomas involving the optic pathway are exceedingly rare.Temporal lobe epilepsy and multiple lesions in the optic pathway are characteristic clinical manifestations. The main purpose of surgical treatment is the control of epilepsy. Undue removal of non-epileptogenic tumor focus will aggravate visual function loss.
Objective To summarize the experience of diagnosis and treatment for multifocal gangliogliomas with epilepsy in the optic pathway. Methods Clinical data of 2 patients with multifocal gangliogliomas in the optic pathway, whose first symptom was epilepsy,were analyzed retrospectively. Multi-lesions along the left optic pathway were showed on the MRI including optic chiasm, tract and lateral geniculate body. Left temporal lobe epilepsy was diagnosed by preoperative evaluation. The patients received left temporal lobe tailored resection(including the amygdale and hippocampus) and partial lesion excision(including optic chiasma in 1 case) under awake anesthetic condition. Results The postoperative optic field defects worsened to different degrees. Ganglioglioma as the lesion and focal cortical dysplasia of the temporal lobe were confirmed by pathologic examination. According to Engel classification, the seizure control achieved grade Ⅱa or Ⅰa in the two patients during postoperative follow up. Conclusions Ganglioglioma is a benign neuronal-glial cell mixed tumor(WHO I). The most common symptom is seizure. Gangliogliomas involving the optic pathway are exceedingly rare.Temporal lobe epilepsy and multiple lesions in the optic pathway are characteristic clinical manifestations. The main purpose of surgical treatment is the control of epilepsy. Undue removal of non-epileptogenic tumor focus will aggravate visual function loss.
引文
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[4]PHI J H,PAENG J C,LEE H S,et al.Evaluation of focal cortical dysplasia and mixed neuronal and glial tumors in pediatric epilepsy patients using18F-FDG and11C-methionine PET[J].J Nucl Med,2010,51(5):728-734.
[5]OGIWARA H,NORDLI D R,DIPATRI A J,et al.Pediatric epileptogenic gangliogliomas:seizure outcome and surgical results[J].J Neurosurg Pedia,2010,5(3):271-276.
[6]COMPTON J J,LAACK N N,ECKEL L J,et al.Longterm outcomes for low-grade intracranial ganglioglioma:30-year experience from the Mayo Clinic[J].J Neurosurg,2012,117(5):825-830.
[7]ENGLOT D J,BERGER M S,BARBARO N M,et al.Factors associated with seizure freedom in the surgical resection of glioneuronal tumors[J].Epilepsia,2012,53(1):51-57.
[8]BONNEY P A,GLENN C A,EBELING P A,et al.Seizure freedom rates and prognostic indicators after resection of gangliogliomas:a review[J].World Neurosurg,2015,84(6):1988-1996.
[9]FERRIER C H,ARONICA E,LEIJTEN F S,et al.Electrocorticographic discharge patterns in glioneuronal tumors and focal cortical dysplasia[J].Epilepsia,2006,47(9):1477-1486.
[10]ARONICA E,REDEKER S,BOER K,et al.Inhibitory networks in epilepsy-associated gangliogliomas and in the perilesional epileptic cortex[J].Epilep Res,2007,74(1):33-44.
[11]SAMADANI U,JUDKINS A R,AKPALU A,et al.Differential cellular gene expression in ganglioglioma[J].Epilepsia,2007,48(4):646-653.
[12]SCHMITZ A K,GROTE A,RAABE A,et al.Albumin storage in neoplastic astroglial elements of gangliogliomas[J].Seizure,2013,22(2):144-150.
[13]CRINO P B.Focal brain malformations:seizures,signaling,sequencing[J].Epilepsia,2009,50(S9):3-8.
[14]ARONICA E,CRINO P B.Epilepsy related to developmental tumors and malformations of cortical development[J].Neurotherapeutics,2014,11(2):251-268.
[15]WRIGHT K W,SPIEGEL P H,THOMPSON L S.Handbook of Pediatric Neuro-Ophthalmology[M].2nd ed.New York:Springer Science Business Media,2006:30-32.
[2]LOUIS D N,OHGAKI H,WIESTLER O D,et al.WHOClassification of Tumours of the Central Nervous System[M].4th ed.Lyon:IARC,2007:103-105.
[3]ROSENBERG D S,DEMARQUAY G,JOUVET A,et al.[11C]-Methionine PET:dysembryoplastic neuroepithelial tumours compared with other epileptogenic brain neoplasms[J].J Neurol Neurosurg Psychiatry,2005,76(12):1686-1692.
[4]PHI J H,PAENG J C,LEE H S,et al.Evaluation of focal cortical dysplasia and mixed neuronal and glial tumors in pediatric epilepsy patients using18F-FDG and11C-methionine PET[J].J Nucl Med,2010,51(5):728-734.
[5]OGIWARA H,NORDLI D R,DIPATRI A J,et al.Pediatric epileptogenic gangliogliomas:seizure outcome and surgical results[J].J Neurosurg Pedia,2010,5(3):271-276.
[6]COMPTON J J,LAACK N N,ECKEL L J,et al.Longterm outcomes for low-grade intracranial ganglioglioma:30-year experience from the Mayo Clinic[J].J Neurosurg,2012,117(5):825-830.
[7]ENGLOT D J,BERGER M S,BARBARO N M,et al.Factors associated with seizure freedom in the surgical resection of glioneuronal tumors[J].Epilepsia,2012,53(1):51-57.
[8]BONNEY P A,GLENN C A,EBELING P A,et al.Seizure freedom rates and prognostic indicators after resection of gangliogliomas:a review[J].World Neurosurg,2015,84(6):1988-1996.
[9]FERRIER C H,ARONICA E,LEIJTEN F S,et al.Electrocorticographic discharge patterns in glioneuronal tumors and focal cortical dysplasia[J].Epilepsia,2006,47(9):1477-1486.
[10]ARONICA E,REDEKER S,BOER K,et al.Inhibitory networks in epilepsy-associated gangliogliomas and in the perilesional epileptic cortex[J].Epilep Res,2007,74(1):33-44.
[11]SAMADANI U,JUDKINS A R,AKPALU A,et al.Differential cellular gene expression in ganglioglioma[J].Epilepsia,2007,48(4):646-653.
[12]SCHMITZ A K,GROTE A,RAABE A,et al.Albumin storage in neoplastic astroglial elements of gangliogliomas[J].Seizure,2013,22(2):144-150.
[13]CRINO P B.Focal brain malformations:seizures,signaling,sequencing[J].Epilepsia,2009,50(S9):3-8.
[14]ARONICA E,CRINO P B.Epilepsy related to developmental tumors and malformations of cortical development[J].Neurotherapeutics,2014,11(2):251-268.
[15]WRIGHT K W,SPIEGEL P H,THOMPSON L S.Handbook of Pediatric Neuro-Ophthalmology[M].2nd ed.New York:Springer Science Business Media,2006:30-32.