成人视路胶质瘤的诊断与显微外科治疗

Diagnosis and treatment of optic pathway glioma in adult

目的报道8例成人视路胶质瘤,并结合文献讨论了成人视路胶质瘤的临床特点、影像学改变及显微手术方法。方法8例患者均行额下入路手术治疗,6例术中镜下全切除肿瘤、1例部分切除、1例仅行活检,术后此2例患者接受了放射治疗(失随访)。余6名患者随访8个月￣3a,平均1.26a。结果术后6例患者视力改善、2例视力无变化。无死亡病例。病理:5例为胶质瘤I～Ⅱ级,3例为胶质瘤Ⅱ、Ⅲ级。结论成人视神经胶质瘤最早的临床表现为视力下降,结合MRI的影像学改变,术前应可做出高度倾向性的诊断。成人视路胶质瘤多累及视交叉,仅发生于一侧视神经者少见。显微手术有可能全切除肿瘤,肿瘤全切除患者的生存期较文献报告延长。无法全切除者术后应辅以放疗。

[Objective] To study their imageology and clinical characteristic as well as surgical strategy of 8 cases in adult optic pathway glioma. [Methods] The operations were performed in all of 8 cases. 6 of 8 optic pathway gliomas w ere total removed, and one glioma was part removed, another glioma only biopsy. Radiotherapy were performed in 2 patients which their tumor was not total remove d. [Results] Acuity of vision improved post-operation in 6 patients,no change in 2 patients; Pathology: 5 cases with glioma I～Ⅱgrade and 3 cases with Ⅱ～ Ⅲ. [Conclusions] Visual disorder is the most original clinical symptoms in ad ult optic pathway glioma and the tumor often involve the chiasm. Total remove th e tumor is possible when micro-operation. Radiotherapy should be performed when tumor residue.