“脑室型”胼胝体胶质瘤的手术治疗
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摘要
目的探讨"脑室型"胼胝体胶质瘤的手术治疗效果。方法回顾性分析新疆医科大学第一附属医院神经外科自2015年1月—2018年1月手术,并经病理检查证实的12例"脑室型"胼胝体胶质瘤患者的临床资料、显微外科手术方式及病理结果;评价患者的肿瘤切除程度及术后临床效果。采用电话、门诊等方式对患者进行随访。结果肿瘤次全切除患者9例,大部分切除者3例。术后病理检查示,9例患者为胶质母细胞瘤(WHOⅣ级),2例患者为弥漫性星形细胞瘤(WHOⅡ级),1例患者为间变型星形细胞瘤(WHOⅢ级)。术后,颅高压症状改善者7例,言语障碍改善者1例,认知功能障碍改善1例,大小便失禁改善2例。术后KPS评分> 60分者7例,<60分者5例。随访3个月—3年,2例患者存活,其余患者均死亡。结论"脑室型"胼胝体胶质瘤多合并颅内压增高症状、认知功能障碍、梗阻性脑积水;肿瘤侵犯结构广泛,手术部位深、难度大、风险高,肿瘤难以全切;病理类型多为胶质母细胞瘤,预后差。显微外科手术治疗的近期效果较好,能有效缓解颅内高压症状,提高患者的生存质量。
Objective To investigate the microsurgical effect of "intraventricular type"corpus callosum glioma. Methods The clinical data,microsurgical treatment and pathological results of 12 cases of "Intraventricular type"corpus callosum gliomas treated in the First Teaching Hospital of Xinjiang Medical University from January 2015 to January 2018 were analyzed retrospectively. The degree of tumor resection and the postoperative clinical performance were evaluated. The follow-up was carried out by telephone and outpatient clinic. Results 9 cases received subtotal resection and 3 received partial resection. 9 were glioblastoma WHO Ⅳ grade,2 were diffused astrocytoma WHOⅡ grade and 1 was anaplastic astrocytoma WHO Ⅲ grade. Postoperative symptoms of cranial hypertension improved in 7 cases,speech disorder improved in 1,cognitive impairment improved in 1 case and gatism improved in 2 cases. 7 cases of postoperative KPS score was > 60 and 5 cases was< 60. The follow-up from 3 months to 3 years showed 2 cases survived and the others all died.Conclusions "Intraventricular type"corpus callosum glioma usually combines with intracranial hypertension,cognitive dysfunction and obstructive hydrocephalus. The operation is difficult and risky because of its deep position and extensive invasion. The tumor seldom receives total resection.Most of them are glioblastoma,this histopathology result doomed to poor prognosis. The short-term effect of microsurgical treatment for "intraventricular type"corpus callosum glioma is better. It can effectively relieve the symptoms of intracranial hypertension and improve the quality of life of patients.
Objective To investigate the microsurgical effect of "intraventricular type"corpus callosum glioma. Methods The clinical data,microsurgical treatment and pathological results of 12 cases of "Intraventricular type"corpus callosum gliomas treated in the First Teaching Hospital of Xinjiang Medical University from January 2015 to January 2018 were analyzed retrospectively. The degree of tumor resection and the postoperative clinical performance were evaluated. The follow-up was carried out by telephone and outpatient clinic. Results 9 cases received subtotal resection and 3 received partial resection. 9 were glioblastoma WHO Ⅳ grade,2 were diffused astrocytoma WHOⅡ grade and 1 was anaplastic astrocytoma WHO Ⅲ grade. Postoperative symptoms of cranial hypertension improved in 7 cases,speech disorder improved in 1,cognitive impairment improved in 1 case and gatism improved in 2 cases. 7 cases of postoperative KPS score was > 60 and 5 cases was< 60. The follow-up from 3 months to 3 years showed 2 cases survived and the others all died.Conclusions "Intraventricular type"corpus callosum glioma usually combines with intracranial hypertension,cognitive dysfunction and obstructive hydrocephalus. The operation is difficult and risky because of its deep position and extensive invasion. The tumor seldom receives total resection.Most of them are glioblastoma,this histopathology result doomed to poor prognosis. The short-term effect of microsurgical treatment for "intraventricular type"corpus callosum glioma is better. It can effectively relieve the symptoms of intracranial hypertension and improve the quality of life of patients.
引文
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[12]Monaco IE,Armah HB,Nikiforova MN,et al.GradeⅡoligodendroglioma localized to the corpus callosum[J].Brain Tumor Pathol,2011,28:305.
[13]Liang TH,Kuo SH,Wang CW,et al.Adverse prognosis and distinct progression patterns after concurrent chemoradiotherapy for glioblastoma with synchronous subventricular zone and corpus callosum invasion[J].Radiother Oncol,2016,118:16.
[14]Rossmeisl JH,Clapp K,Pancotto TE,et al.Canine butterfly glioblastomas:a neuroradiological review[J]Front Vet Sci,2016,3:40.
[15]Krishnan V,Lim TC,Ho FC,et al.Clinics in diagnostic imaging(175)[J].Singapore Med J,2017,58:121.
[16]Opokudarko M,Amuah JE,Kelly J.Surgical resection of anterior and posterior butterfly glioblastoma[J].World Neurosurg,2018,110:e612.
[17]Kallenberg K,Goldmann T,Menke J,et al.Glioma infiltration of the corpus callosum:early signs detected by DTI[J].JNeurooncol,2013,112:217.
[18]李鑫,张鹏飞,韩利江,等.成人丘脑恶性胶质瘤手术治疗[J].中华神经外科疾病研究杂志,2017,16:146.
[19]郑虎,张红波,孙彦辉,等.脑肿瘤患者认知障碍数据库的初步建立及临床意义[J].数理医药学杂志,2013,26:410.
[20]李信晓,王峰,刘阳,等.典型蝴蝶状胼胝体胶质瘤1例报告并文献复习[J].临床神经外科杂志,2017,14:335.
[2]伍碧武,张义,汪洋,等.显微外科手术治疗丘脑胶质瘤及预后分析[J].中华神经外科杂志,2015,31:1201.
[3]张义,庄冬晓,花玮,等.经胼胝体侧脑室入路丘脑胶质瘤切除术[J].中华神经外科杂志,2013,29:70.
[4]张红波,穆林森,孙彦辉,等.脑肿瘤患者围手术期认知功能障碍的临床研究[J].中华神经外科杂志,2015,31:225.
[5]朱江.胼胝体前部胶质瘤的临床特点及应用显微手术切除的可行性[J].中国实用神经疾病杂志,2013,16:26.
[6]Burks JD,Bonney PA,Conner AK,et al.A method for safely resecting anterior butterfly gliomas:the surgical anatomy of the default mode network and the relevance of its preservation[J].JNeurosurg,2017,126:1795.
[7]Chen KT,Wu TW,Chuang CC,et al.Corpus callosum involvement and postoperative outcomes of patients with gliomas[J].JNeurooncol,2015,124:207.
[8]Mickevicius NJ,Carle AB,Bluemel TA,et al.Location of brain tumor intersecting white matter tracts predicts patient prognosis[J].J Neurooncol,2015,125:393.
[9]Liang TH,Kuo SH,Wang CW,et al.Adverse prognosis and distinct progression patterns after concurrent chemoradiotherapy for glioblastoma with synchronous subventricular zone and corpus callosum invasion[J].Radiother Oncol,2016,118:16.
[10]Kaisorn LC,Ignacio JT,Ana ML,et al.The butterfly effect on glioblastoma:is volumetric extent of resection more effective than biopsy for these tumors[J].J Neurooncol,2014,120:625.
[11]Ho ML,Moonis G,Ginet DT,et al.Lesions of the corpus callosum[J].AJR,2013,200:W1.
[12]Monaco IE,Armah HB,Nikiforova MN,et al.GradeⅡoligodendroglioma localized to the corpus callosum[J].Brain Tumor Pathol,2011,28:305.
[13]Liang TH,Kuo SH,Wang CW,et al.Adverse prognosis and distinct progression patterns after concurrent chemoradiotherapy for glioblastoma with synchronous subventricular zone and corpus callosum invasion[J].Radiother Oncol,2016,118:16.
[14]Rossmeisl JH,Clapp K,Pancotto TE,et al.Canine butterfly glioblastomas:a neuroradiological review[J]Front Vet Sci,2016,3:40.
[15]Krishnan V,Lim TC,Ho FC,et al.Clinics in diagnostic imaging(175)[J].Singapore Med J,2017,58:121.
[16]Opokudarko M,Amuah JE,Kelly J.Surgical resection of anterior and posterior butterfly glioblastoma[J].World Neurosurg,2018,110:e612.
[17]Kallenberg K,Goldmann T,Menke J,et al.Glioma infiltration of the corpus callosum:early signs detected by DTI[J].JNeurooncol,2013,112:217.
[18]李鑫,张鹏飞,韩利江,等.成人丘脑恶性胶质瘤手术治疗[J].中华神经外科疾病研究杂志,2017,16:146.
[19]郑虎,张红波,孙彦辉,等.脑肿瘤患者认知障碍数据库的初步建立及临床意义[J].数理医药学杂志,2013,26:410.
[20]李信晓,王峰,刘阳,等.典型蝴蝶状胼胝体胶质瘤1例报告并文献复习[J].临床神经外科杂志,2017,14:335.