松果体实质肿瘤的诊断与治疗

Diagnosis and treatment for pineal parenchymal tumors

目的探讨松果体实质肿瘤的诊断和治疗方法。方法回顾性分析35例松果体实质肿瘤患者（松果体细胞瘤10例，中分化松果体实质肿瘤13例，松果体母细胞瘤12例）。CT及MRI示松果体区团块样肿物，松果体细胞瘤边界规则、清楚，增强均匀。恶性松果体实质肿瘤边界不清、分叶状，不均匀增强。手术选择Poppen入路16例，经胼胝体一穹窿间入路16例，幕下小脑上入路1例和三角区入路2例。结果肿瘤全切除13例，近全切除16例，部分切除6例。术中多数肿瘤与周围组织有粘连。术后23例患者进行了放射治疗。随访7例患者因肿瘤复发死亡。中分化松果体实质肿瘤和松果体母细胞瘤的中位生存期分别为28．2个月和47．6个月。结论术前影像学检查有助于判断良恶性肿瘤。松果体细胞瘤手术治疗效果良好。中分化松果体实质肿瘤和松果体母细胞瘤治疗首选手术联合放射治疗，但预后较差。

Objective Pineal parenchymal tumors are rare intracranial tumors . We studied the clinical features, neuro - radiology and pathology of pineal parenchymal tumors and discussed the treatment strategy. Methods There were 35 pineal parenchymal tumors patients （10 pineocytoma, 13 pineal parenchymal tumor of intermediate differentiation, 12 pineoblastoma） involved in this study. CT and MRI revealed pineocytoma to be round and have regular margins. Pineal parenchymal tumor of intermediate differentiation and pineoblastoma were lobular, irregular marginal and heterogenous enhancement. Poppen approach was performed in 16 cases, transcallosum approach in 16 cases, subtentorial -supracerebellar approach in 1 case and transtrigone lateral ventricle approach in 1 case. Results All of the tumors were surgically removed, including 13 totally removed, 16 subtotally removed and 6 partially removed. 23 patients received radiotherapy after operation. During the follow up there was 7 patients died because of tumor recurrence. Conclusions Pineocytoma patients have good survival prognosis after surgical treatment. Microsurgery combining with radiotherapy represents the most effective therapy for pineal parenchymal tumor of intermediate differentiation and pineoblastoma. Although these tumors have poor prognosis and more efforts should be made to improve the level of treatment.