颅内单发脱髓鞘假瘤的诊治分析

Diagnosis and treatment of intracranial single demyelinating pseudotumor

目的 总结颅内单发脱髓鞘假瘤(DPT)的诊治经验。方法 回顾性分析2011年5月至2021年6月收治的19例DPT的临床资料。结果 19例术前均考虑胶质瘤,开颅手术探查;17例术中快速病理结果为脱髓鞘病变或胶质增生,终止手术并给予激素治疗;2例术中快速病理为高级别胶质瘤,行病灶全切除,术后病理结果为胶质增生,病情进展再次手术病理检查确诊为DPT。术后4周复查头部MRI,15例病灶缩小,4例病灶消失;术后2个月复查头部MRI示病灶均完全消失。术后3个月,14例临床症状完全消失,2例遗留肢体偏瘫,3例遗留不同程度失语,1例意识朦胧。结论 DPT是中枢神经系统特有的炎症性疾病,及时诊断并给予相应治疗,预后良好,但易误诊为肿瘤性病变;因此,对于临床表现不典型的颅内炎症性疾病,怀疑肿瘤性病变时,应完善各种检查,降低误诊率,避免不必要的开颅手术。

Objective To summarize the experience in diagnosis and treatment of intracranial single demyelinating pseudotumor(DPT). Methods The clinical data of 19 patients with DPT who were difinitely dignosed as DPT by postoperative pathological examination from May 2011 to June 2021 were retrospectively analyzed. Results All the patients were considered as glioma before operation and craniotomy was performed in all the patients. The rapid intraopertative pathological results showed demyelinating lesions or gliosis in 17 patients who received hormone therapy, and high-grade glioma in the other 2 patients who underwent total resection of lesions. The postoperative pathological findings showed DPT in all the patients. Four weeks after operation, MRI showed that the lesions were reduced in 15 patients and disappeared in 4. Two months after operation, MRI showed that all lesions disappeared completely.Three months after operation, the symptoms disappeared completely in 14 patients, 2 patients were left with hemiplegia, 3 with aphasia,and 1 with confusion of consciousness. Conclusions DPT is a unique inflammatory disease of the central nervous system. The prognosis is good after timely diagnosis and treatment, but it is easy to be misdiagnosed as neoplastic disease. Therefore, for intracranial inflammatory diseases with atypical clinical manifestations, various examinations should be performed to reduce the misdiagnosis rate and avoid unnecessary craniotomy.