小儿脑干胶质瘤的显微手术治疗

Microsurgical management of childhood brainstem glioma

目的 探讨显微手术在小儿脑干胶质瘤治疗中的作用以及手术的适应证。方法 对18例显微手术治疗的脑干胶质瘤患儿的临床资料，术中影像资料和术后随访检查结果进行分析总结。结果 肿瘤全切除12例，次全切除4例，部分切除2例，其中9例术后进行放疗。平均随访2．8年，总体效果良好。结论 适应证明确的脑干胶质瘤患儿应积极显微手术治疗。在选择手术患儿时，除肿瘤系外生型、内生局限型或颈延髓型外，MRI上有局限性强化灶和神经功能缺失不明显也是重要的手术指征。

Objective To explore the role and indication of microsurgery in childhood brainstem glioma. Methods We retrospectively reviewed all children diagnosed as brainstem glioma and treated by microsurgery from 1996 to 2005. All of the 18 patients underwent surgical resection of the tumor as initial treatment with the goal of achieving gross total removal of the tumor. All children had a magnetic resonance imaging （MRI） after surgery to evaluate the results of the initial treatment. The CT and MRI features of the lesions and clinical characteristics were analyzed. Results The degree of resection was based on the review of imaging. Gross total resection defined as the absence of residue on the MRI, was achieved in 12 children. Subtotal removal was obtained in 4 children, and 2 children had partial resection. Nine patients received postsurgical radiotherapy. All patients were followed up, and most of them were long time survivors. Conclusion The use of microsurgery is a strategy that aggressive therapy in select the children with brainstem glioma.