颅内段视神经胶质瘤的显微外科治疗

Surgical treatment of gliomas of optic nerve and chiasm nerve

目的探讨颅内段视神经胶质瘤的临床表现、诊断与治疗方法。方法回顾性分析9例颅内段视神经胶质瘤患者的CT和MRI影像、临床表现和手术治疗结果。结果3例患者经鼻-蝶窦入路显微镜下手术切除,6例经翼点入路显微镜下开颅手术切除;全切除3例、近全切除4例,部分切除2例。病理报告为星形细胞瘤Ⅰ～Ⅱ级6例,Ⅱ～Ⅲ级3例。7例手术后放射治疗。结论该病以儿童及年轻患者多见,临床表现以头痛、视力障碍和内分泌改变为主。CT和MRI扫描可协助诊断。仅累及视神经的胶质瘤多数呈低度恶性,应尽可能在显微手术下全切除;同时侵犯视交叉的胶质瘤恶性程度较高,效果不佳。放疗和化疗对防止肿瘤复发有一定效果。

Objective To investigate the clinical manifestation,radiological and pathological characteristics of gliomas of optic and chiasm nerve. Methods Clinical data of 9 patients with gliomas of optic and chiasm nerve were reviewed retrospectively.Results The tumor was resected by transsphenoidal operation in 3 cases and pterional approach in 6 patients. Total tumor resection was performed in 3cases,subtotal removal in 4 cases and partial removal in 2 cases. The pathological grade（WHO 1999） was astrocytic tumorⅠ～Ⅱ in 6 cases,Ⅱ～Ⅲ in 3 cases.Of 9 patients,7 cases received radiotherapy. Conclusion The tumor is mostly seen in children or young patients.Microsurgery is advocated for resection of the tumors involving the optic nerve.Radiotherapy and chemotherapy are helpful for preventing relapse of the tumor.