扣带回胶质瘤的临床特点及其锁孔手术治疗

Cinical Characters and Keyhole Surgery of Cingulate Gyrus Gliomas

目的分析总结扣带回胶质瘤的临床特点及其锁孔入路治疗的临床效果和意义。方法回顾性分析天坛医院神经外科2001年1月至2003年12月收治的31例扣带回胶质瘤病例,归纳总结其临床特点、肿瘤影像学表现和病理学特点,并对手术效果进行分析。结果患者均以癫痫发作为首发症状,肿瘤局限于扣带回内生长,病理学上均为低级别胶质瘤(WHO分级Ⅱ级)。全部病例均采用经纵裂锁孔手术入路,手术全切除25例,近全切除6例。全部病例术后癫痫症状缓解,术后一过性对侧肢体偏瘫3例,无手术死亡。平均随访26个月,无术后复发。结论扣带回胶质瘤以癫痫发作为常见首发症状,生长方式局限于扣带回,均为低级别胶质瘤。经纵裂锁孔入路手术创伤小,手术效果良好。

Objective To summarize and analyse the clinical characters and keyhole surgery results of cingulate gyrus gliomas. Methods The clinical manifestations, radiological findings and pathological characters of 31 cases of cingulate gyrus admitted from January 2001 to December 2003 were studied retrospectively. All cases were operated by keyhole trans-longitudinal fissure approach. The surgical results was analyzed. Results Seizure occurred as an initial symptom in all of the 31 case. The tumors grew exactly within the cingulate gyrus; And all cases were demonstrated as low-grade gliomas by pathological examination （WHO Ⅱ ）. Among them, 25 cases were removed totally and 6 were subtotally. Seizure free were achieved in all cases. 3 cases presented transient contralateral limb paralysis. There was no mortality and recurrence during follow-up of mean 26 months. Conclusion Seizures as the initial manifestation, growing locally within the cingulate gyrus and low-grade glioma pathologically are the main clinical characters of cingulate gyrus gliomas. The keyhole trans-longitudinal fissure approach is a minimally invasive and practical way in the treatment of cingulate gyrus gliomas.