脑干神经节胶质瘤的诊断及治疗

Diagnosis and surgical treatment of ganglioglioma in the brain stem

目的总结脑干神经节胶质瘤的诊治经验。方法回顾性分析10例脑干神经节胶质瘤的临床资料。肿瘤均位于延髓,其中单纯位于延髓3例,累及上颈髓3例,累及脑桥3例,累及小脑1例。均经枕下后正中入路,行显微手术治疗。结果肿瘤近全切除6例,大部分切除2例,部分切除2例。术后辅助放疗2例。病理诊断为神经节胶质瘤。随访3个月～12年,失访2例;存活7例,未见肿瘤复发;术后4个月因急性呼吸道梗阻死亡1例。结论显微神经外科手术是脑干神经节胶质瘤的首选治疗方法,手术主要切除突出到脑干外及脑干内相对表浅的肿瘤。脑干神经节胶质瘤预后较好,后组脑神经麻痹是其主要术后并发症。

Objective To review the diagnosis and treatment experiences of gangliogliomas in the brain stem.Methods Clinical data of 10 patients with gangliogliomas in the brain stem were analyzed retrospectively.All the tumors were located in the medulla oblongata,including involved merely medulla oblongata in 3 cases,upper spinal cord in 3,pons in 3,cerebellum in 1.All the patients underwent microsurgery via suboccipital midline approach.Results Subtotal resection of the tumor was achieved in 6 cases,major resection in 2 and minor resection in 2.Two patients received postoperative adjunctive radiotherapy.All the tumors were diagnosed as gangliogliomas by pathological analysis.A follow-up of 3 months to 12 years were performed excluding 2 cases,7 patients survived without recurrence and 1 died of acute respiratory obstruction at 4 months after operation.Conclusions Surgical resection is the first treatment for the ganglioglioma in the brain stem,and remove relatively superficial tumors protruding to the inside or outside of the brain stem predominantly.The prognosis of brain stem ganglioglioma is good and posterior cranial nerve palsy is the primary complication after the operation.