摘要
目的探讨儿童丘脑基底节肿瘤的临床特点与治疗策略。方法回顾性分析上海华山医院治疗的66例经病理证实的儿童丘脑基底节肿瘤。根据手术方式的不同将以上病例分为导航下穿刺活检组和开颅手术组。比较两种手术方法的手术时间、术后并发症、住院时间和手术效果。对于不同类型的肿瘤术后针对性地辅助放、化疗,根据病理分型的不同,比较两组手术方法的生存率。并用多因素回归分析的方法寻找影响术后生存率及运动功能障碍的原因。结果66例患者中男49例,女17例,年龄4~16岁。经病理证实高级别胶质瘤16例,低级别胶质瘤14例,毛细胞型星形细胞瘤9例,生殖细胞肿瘤19例,恶性淋巴瘤1例,其他类肿瘤7例。所有病例均接受手术治疗,导航穿刺活检组19例;开颅手术组47例,其中肿瘤全切除27例,次全切除14例,部分切除6例。共随访到59例(89.4%),总的5年生存率为65.2%。对于不同类别的胶质瘤和生殖细胞肿瘤的术后生存率,导航下穿刺活检组和开颅组差异无统计学意义(P〉0.05)。导航下穿刺活检组在手术时间,术后住院天数,安全性上均优于开颅组,且术后并发症和后遗症发生率低(P〈0.05)。COX多因素回归分析揭示影响术后生存率的惟一因素为肿瘤的病理分型(P〈0.05)。Logistic多因素分析显示肿瘤的病理分型与术前运动障碍程度对术后运动功能障碍有显著相关性(P〈0.05)。结论儿童丘脑基底节肿瘤的治疗方案,除了术前影像学已经明确为海绵状血管瘤外,应先进行MRI导航下穿刺活检术,明确病理后实施个性化的治疗方案。这样可以减小创伤,最大限度地保护神经功能。
Objective To discuss the clinical feature, treatment strategy of childhood intracranial tumors originating in basal ganglia and thalamus. Method The records of 66 children who suffered from tumors arising from basal ganglia and thalamus based on iconography and treated in Shanghai Huashan hospital were reviewed retrospectively. Based on the histology, patients were divided into Frameless image - guided biopsy group and craniotomy group for analyzing its prognosis by survival rate, complications, operating time, hospital stay, and treatment effect. Results In these 66 cases, there were 16 cases of high grade glioma, 14 low grade glioma, 9 pilocytic astrocytoma, 19 germ cell tumors, I lymphomas, and 7 other tumors. All patients were treated surgically. The tumor was totally removed in 27 cases, sub - totally in 14, and partially in 6. Frameless image - guided biopsy was performed in the other 19 cases. 59 patients (89.4%) were successfully followed up. The common 5 - year survival rate was 65.2%. For high and low grade glioma, germ cell tumors, there was no significant different between Frameless image -guided biopsy and eraniotomy group in prognosis of survival rate ( P 〉 0. 05 ). The reliability ratio, postoperative hospital stay time of frameless image - guided group were better than that of craniotomy group while the sequelae and complication ratios of frameless image - guided biopsy group were much lower than that of craniotomy group (P 〈 0.05 ). COX analysis showed the only factor which influent post - operative survival rate was the histology of tumors (P 〈 0. 05 ). Further logistic analysis showed the histology of tumors and the degree of pre- surgical movement disorder were strongly correlated with movement disorder post operation. Conclusions Frameless image - guided biopsy is the first choice for childhood brain tumors originating from basal ganglia and thalamus, except hemangioma that were obviously confirmed by iconography. Magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) can help to choose surgical approach and prediet prognosis. This treatment strategy not only can make the pathological diagnosis for further treatment, but also can reduce the sequelae and preserve the neuro -function.
出处
《中华神经外科杂志》
CSCD
北大核心
2012年第10期982-986,共5页
Chinese Journal of Neurosurgery
关键词
基底节
丘脑
脑肿瘤
治疗
Basal ganglia
Thalamus
Brain neoplasms
Therapy