儿童脑干胶质瘤的治疗分析

Analysis of the treatment of the brainstem glioma in children

目的通过回顾性分析,探讨儿童脑干不同部位胶质瘤的治疗。方法对5年间可随访的、经MRI影像学证实为脑干胶质瘤的33例患儿进行分析,男19例、女14例,肿瘤位于中脑顶盖区2例,中脑3例,桥脑17例,延髓3例,位于中脑桥脑5例、桥脑延髓2例,桥延髓颈髓1例,将患者分成手术组、放疗组、未治疗组。结果手术组15例有7例存活,术后生存期17～52个月,8例死亡,术后存活1.5～12个月;放疗组7例有4例死亡,存活期分别为2、4、11、24个月,3例存活3、7.5、17个月。结论不同部位的儿童脑干胶质瘤应采取个体化的治疗,其中顶盖胶质瘤伴发脑积水应行脑脊液转流术,局灶性外生性或肿瘤表面脑组织少的局灶性内生性行手术治疗,而弥漫性者行放疗。

Objective Using tile retrospective analysis to discuss the treatment of the gliomas in the different parts of the brainstem in childhood. Methods The 33 cases of pediatric brainstem gliomas were included in this study, which diagnosed by MRI primarily from 2004 to 2008, 19 males and 14 females. After five years＇ following up, data was colleeted and patients were divided into 3 groups, surgical, radiotherapy and untreated group. Two tumors located in the rectum, 3 in the midbrain, 17 in the pons, 3 in the medulla oblongata. And other tumors involving pontomesencephalon, pontomedulla, pontine and cervicomedulla were 5, 2, and 1 respectively. Results Fifteen patients were treated with surgery （operation group）, eight of them died whose postoperative survival was 1.5 to 12 months, whereas seven are still alive and their postoperative survival reached 17 to 52 months. Seven patients were treated with radiotherapy （ radiotherapy group） , four of them died and three are alive. Conclusion Based on the imaging findings, we should choose an appropriate intervention for the children brainstem gliomas. Some patients with tectal tumors maybe managed with creating a diversion for CSF. Either focal exophytie tumor or focal intrinsic tumor with little neural tissue on its surface should be managed surgically. Furthermore, radiotherapy provides a safe method for the diffuse brainstem gliomas.