岛叶及岛盖胶质瘤的误诊原因分析及处理

Analysis of misdiagnosis and treatment of gliomas in insulae and operculum insulae

目的研究岛叶及岛盖胶质瘤的临床及影像特征,早期诊断,提高治疗效果。方法对5年内手术治疗的312例胶质瘤中误诊的19例岛叶及岛盖胶质瘤进行了回顾性研究,并对患者进行了随访。结果CT显示岛叶及额、颞、顶的岛盖皮层低密度病变。MRI提示额、颞、顶岛盖区及岛叶T1低信号区域,T2高信号区域,Flair像上环侧裂血管大脑皮层的高信号区,没有明显的边界和典型的肿瘤团块,中线无明显移位。手术中显微镜下所见:肿瘤组织生长于额叶、颞叶、顶叶岛盖面及岛叶表面的软膜下或/和突破软膜到蛛网膜下腔,侵蚀皮层,肿瘤呈灰白色或灰紫色,质地较软,易于吸除,与正常组织边界模糊,肿瘤供血不丰富,肿瘤切除后可见动脉血管深穿枝向正常脑组织供血。手术后病理报告星形细胞瘤Ⅰ-Ⅱ级或星形细胞-少突胶质细胞瘤Ⅰ-Ⅱ级。手术后CT或MRI显示肿瘤全切除13例,大部切除4例,部分切除2例。癫痫症状及头痛症状消失15例,改善3例,手术后1例患者增加对侧下肢力弱的症状。所有患者都进行了随访,仅1例失访,随访期限6个月-3年4个月,患者没有新增加的症状和体征,影像学检查2例提示肿瘤复发。所有患者能够正常生活,11例患者恢复正常工作结论岛叶及岛盖胶质瘤有其独特的病史及影像特征,掌握其演变规律可以做出正确的诊断,早期手术能够获得良好的治疗效果。

Objective To study clinical and imaging characteristics of glioma in insulae and operculum insulae for making early diagnosis and improving the prognosis of surgical treatment. Methods 312 cases underwent tumor resection for gliomas at our institution between 2002 and 2006, 19 cases of them were in insulae and operculum insulae which were misdiagnosed, Author analyzed the clinical materials, imaging, pathological results retrospectively and follow-up. Results CT scan demonstrate the low density lesion in insulae and opereulum insulae. MPd show low Tl-weighted single, high T2-weighted and Flair-weighted single of the same region, without clear boundary , typical tumor-like mass and midline-shift. Under microscope （during the surgery）, the tumor raise from subpia mater of the insulae and of the operculum insulae , and/or invade subarachnoid space and cotex. This tumor tissue have features of gray and purple color, soft texture, blur boundary and few blood-supply. The pathological results show astrocytoma grade Ⅰ-Ⅱ or astrocyto oligodendroglioma grade Ⅰ-Ⅱ Postoperative CT or MRI demonstrate 13 cases with total resection, 4 cases with sub-total resection , 2 cases with partial resection. 15 cases recovered from sezure and headache ,3 cases lessened, only one case had aggravation of opposite leg＇ s weak strength. The follow-up period is from 6 months to 3 yrs and 4months（only one case lost）, The whole 19 cases lived in normal fife. 11 cases went back to work. 2 cases with imaging confmned recurrent gliomas. No cases with new symptoms and signs. Conclusion Gliomas in insulae and operculum insulae have special clinical and imaging features,. It is essential to know more about its growth process in order to make a right diagnosis. Surgical resection may have good prognosis in early stages.