视交叉-下丘脑胶质瘤的临床诊治分析

Clinical Diagnosis and Therapy of Opticochiasmatic-hypothalamic Gliomas

目的探讨视交叉-下丘脑胶质瘤的临床特点及其诊治。方法回顾分析2001年6月至2007年6月我科收治的18例视交叉-下丘脑胶质瘤的临床表现、影像学特征及手术治疗情况。结果18例视交叉-下丘脑胶质瘤患者中,2￣23岁16例,32岁和49岁各1例;2例患者伴发神经纤维瘤病Ⅰ型。常见首发症状为头痛。肿瘤次全切除1例,大部分切除13例,部分切除2例,仅活检2例。星形细胞瘤Ⅰ级16例,Ⅱ级2例。术后均辅以放疗和/或化疗。12例随访1￣5年,存活9例,死亡3例。结论视交叉-下丘脑胶质瘤需与颅咽管瘤鉴别。手术以改善症状、明确诊断为目的。采取手术、放疗及化疗的综合治疗,患者预后较佳。

Objective To explore the clinical characteristics, diagnostic and treatmemt of opticochiasmatic-hypothalamic gliomas. Method The clinical data of 18 patients with opticochiasmatic-hypothalamic gliomas, who underwent surgery from June, 2001 to June, 2007 in our department, were analyzed retrospectively. Results The age of 18 patients ranged from 2 to 49 years old. The first common symptom was headache in the patients with opticochiasmatic-hypothalamic gliomas. Two of 18 patients with opticochiasmatic- hypothalamic gliomas had neurofibromatosis Ⅰ. The subtotal resection of the tumor was achieved in 1 case, greatly part resection in 15 cases, part resection in 2 cases and only biopsies were performed in 2 cases. Of 18 cases of gliomas, 16 were belonged in astrocytoma of grade Ⅰ and 2 in grade Ⅱ. Radiotherapy and/or chemotherapy were done after the operation in all the patients. Of 12 patients followed up from 1 to 5 years, 9 survived and 5 died. Conclusions The opticiochiasmatic-hypothalamic gliomas should be differentiated from craniopharyngiomas. The operative purpose is to improve symptoms and make definite diagnosis. The prognosis of patients with opticiochiasmatic-hypothalamic gliomas who received radiotheraphy and chemotherapy after the surgery is relatively good.