介入栓塞结合显微开颅手术在儿童颅内巨大富血管肿瘤中的应用

Application of interventional embolization plus craniotomy for children with giant hypervascular intracranial tumors

目的探讨血管内介入栓塞治疗(endovascular surgery)结合显微开颅手术(microsurgery)的复合手术(hybrid surgery)在儿童颅内巨大富血管肿瘤中的应用价值。方法收集2019年7月至2021年7月湖南省儿童医院神经外科收治的5例儿童颅内巨大富血管肿瘤并接受复合手术的患儿临床资料,收集并分析患儿围手术期并发症及预后情况。结果本研究共纳入5例患儿,其中后颅窝非典型畸胎瘤/横纹肌样瘤(atypical teratoid/rhabdoid tumor,AT/RT)2例(World Health Organization,WHOⅣ级);后颅窝毛细胞型星型细胞瘤(WHOⅠ级)、颞叶室管膜下巨细胞星型细胞瘤(WHOⅠ级)、多型性黄色星型胶质细胞瘤(WHOⅡ级)各1例。患儿均接受复合手术。5例术后均神志清楚,其中4例四肢活动可,术后复查CT均未见颅内出血。出院后3个月随访,MRI复查提示肿瘤未见复发或进展。结论术前介入栓塞治疗可阻断肿瘤主要供血血管,显著减少显微手术切除病变时出血,保持术野清晰,栓塞材料在术中有定位与导航功能,为完整切除颅内巨大富血管肿瘤并尽可能保留正常脑组织、保护脑功能提供了保障。介入栓塞治疗结合显微开颅手术在中枢神经系统肿瘤中具有重要的应用价值。

Objective To explore the application value of endovascular embolization plus microneurosurgery for vascular rich tumors in children.Methods From July 2019 to July 2021,five children with giant intracranial vascular tumor undergoing combined surgery were recruited as research objects.And perioperative complications and outcomes were reviewed retrospectively.Results Among them,there were atypical teratoma/rhabdomyoma(AT/RT)in posterior fossa(WHO GradeⅣ,n=2),hairy cell astrocytoma in posterior fossa(WHO GradeⅠ,n=1),giant cell astrocytoma(WHO GradeⅠ)under ependymal membrane of temporal lobe(WHO GradeⅠ,n=1)and polymorphic yellow astrocytoma(WHO GradeⅡ,n=1).All patients underwent compound surgery.All of them remained conscious post-operation.Four of them could move their limbs and intracranial hemorrhage was absent on postoperative computed tomography(CT).During a follow-up period of 3 months,magnetic resonance imaging(MRI)reexamination showed no tumor recurrence or progression.Conclusion During microsurgery,preoperative occlusion of major tumor blood supply vessels may significantly minimize hemorrhage and maintain a distinct surgical field.And embolic material has the intraoperative function of positioning and navigation so that it ensures a complete resection of huge vascular rich tumors for retaining normal brain tissue as much as possible and protecting brain function.Compound surgery has an important application value for nervous system tumors.