丘脑胶质细胞瘤临床分型探讨——附17例手术治疗报告

Clinical classification of thalamic glioma: report of 17 cases of surgical outcome

目的探讨丘脑胶质细胞瘤临床分型及意义。方法回顾分析2015年1月1日至2017年12月31日在我院住院治疗的17例丘脑胶质细胞瘤患者资料。根据影像学上肿瘤生长的部位将其大体分为丘脑型、丘脑下丘脑型、丘脑脑干型、丘脑基底节区型,其中丘脑型可再细分为单侧型及双侧型。我们报告和说明上述各型的临床特征及治疗效果。结果在列入的17例丘脑胶质细胞瘤患者中,男性12例,女性5例,年龄范围8～66岁,平均35. 2(35. 2±13. 3)岁。10例(59%)肿瘤为丘脑型,其中单侧型7例(41%)、双侧型3例(18%); 1例(6%)为丘脑下丘脑型; 3例(18%)为丘脑脑干型; 3例(18%)为丘脑基底节区型。各型肿瘤中最常见的症状为颅高压引起的头晕、头痛、呕吐,其次表现为一侧肢体乏力及麻木感。术后病理为高级别胶质细胞瘤占65%,低级别胶质细胞瘤占35%。丘脑型胶质细胞瘤高低级别比例大致相等。82%的术后患者KPS评分与术前持平或改善,临床症状较术前改善,但部分遗留不同程度的对侧肌力下降。结果丘脑肿瘤以丘脑型最多见,手术对各型治疗有一定效果,但中线深部的肿瘤限制了手术的干预程度及预后。在作者的经验中,新的分类方法有助于判断患者的预后,但这有待我们的长期随访及更大型系列的研究来证实我们的判断。

Objective The clinical classification and significance of thalamic glioma were investigated.Methods The data of17patients with thalamic glioma who underwent surgery in our hospital in the past3years(from January1to December31,2017)were analyzed,retrospectively.According to imaging,they could be roughly divided into four types,including thalamus,thalamus-hypothalamus,thalamus-brainstem,and thalamus-basal ganglia.The thalamus type could be subdivided into unilateral and bilateral.We reported and described the clinical features and treatments of the above types.Results Of the17patients with thalamic glioma,12were male and5were female.The age ranged from8to66years and averaged35.2(35.2±13.3)years.Ten cases(59%)were thalamic tumors,including7cases(41%)of unilateral thalamic tumors and3cases(18%)of bilateral thalamic tumors.One case(6%)was thalamus-hypothalamic,3cases(18%)were thalamus-brainstem,and3cases(18%)were thalamic-basal ganglia.The most common symptoms in the four types of tumors were intracranial hypertension and dyskinesia.High grade gliomas accounted for65%and low grade gliomas for35%in post-operative pathology.The proportion of high grade and low grade tumors in thalamic gliomas was approximately equal.In82%of post-operative patients,the KPS score was equal to or better than before surgery,and the clinical symptoms were improved compared with the pre-operative ones.However,some of the remaining levels of contralateral muscle strength were decreased.A total of82%of the patients had improved the clinical symptoms after surgery and post-operative KPS scores were the same as before or even improved.However,some patients still suffered from the movement disorders.Conclusion Thalamic tumors are the most common among the four types.Although surgical treatment has a certain effect,the location of tumors in the deep midline limits the surgical intervention.In the author's experience,the new classification method can help determine the prognosis of patient,but this is subject to our long-term follow-up and a larger series of studies to confirm our judgment.