摘要
背景与目的:脑功能区胶质瘤的治疗是神经外科的难题之一。本研究探讨外侧裂区低级别星形细胞瘤的个体化治疗方法,以期达到满意治疗效果。方法:根据术前MRI表现,将56例外侧裂区星形细胞瘤分为4种类型。Ⅰ型:额叶为主型,16例;Ⅱ型:颞叶为主型,13例;Ⅲ型:额-颞跨侧裂型,21例;Ⅳ型:额-颞-岛叶型,6例。依肿瘤特征选择手术进路:Ⅰ型经额前外侧脑沟进路;Ⅱ型经颞前外侧脑沟进路;Ⅲ型和Ⅳ型经外侧裂池进路。在保全神经功能的前提下,显微手术尽可能全切除或多切除肿瘤。术后根据肿瘤级别和特征辅以个体化放疗和/或化疗,平均随访38个月,依据术后MRI和KPS评价治疗结果。结果:肿瘤于镜下全切除39例、次全切除8例、大部分切除6例、部分切除3例;6例遗留永久性轻度神经功能障碍;9例因肿瘤局部复发而行二次手术。术后病理学检查均为WHOⅡ级星形细胞瘤。手术前后KPS无显著性差异。结论:对外侧裂区星形细胞瘤,依据MRI表现,选择个体化的手术进路,应用显微技术,在保全神经功能的前提下,尽可能全切除或多切除肿瘤,最大限度减轻肿瘤负荷,术后辅以个体化放疗和/或化疗,可取得较好的治疗效果。
BACKGROUND ＆ OBJECTIVE：Treatment of glioma in cerebral founctional area is a challenge. This study is to explore personalized treatment of low-grade astrocytoma in sylvian area. MEHTODS： Based on the manifestaion on pre-operative MRI, 56 patients of astrocytoma in sylvian area were classified into 4 types. I frontal type; lI temproral type; Ill frontal-temproral type; Ⅳ frontal-temporal-insular type. Astrocytoma was resected as much as possible by applying micro-neuro-surgical technique. The premise is to preserve cerebral functions at the time of maximum resection. All the patients received the individualized radiotherapy. Thirty nine patients recieved chemotherapy and with an average follow-up duration of 38 months （15-62 months）. Outcome were evaluated by KPS and post-operative MRI images. RESULTS： In 56 patients, the tumors were total resected in 39 cases, subtotally resected in 8 cases and partially resected in 9 cases. The patients resulted in permanent neurological dysfunction in 6 cases. Nine patients received second surgery because of tumor recurrence. All cases were WHO grade Ⅱ astrocytoma. There was no significant change in KPS before and after surgery. CONCLUSIONS：Microsurgery is a safe and effective treatment for astroeytoma in sylvian area. It can optimise adjunctive therapies, radiotherapy and/or chemotherapy for the best possible outcome. KEY WORDS： Sylvian; Astrocytomas; Personal; Treatment
出处
《中国神经肿瘤杂志》
2008年第1期35-38,共4页
Chinese Journal of Neuro-Oncology
