手术联合贝伐单抗治疗罕见成人小脑半球毛细胞黏液型星形细胞瘤1例并文献复习

Surgery combined with bevacizumab for a rare adult cerebellar hemisphere pilomyxoid astrocytomas:report of one case and literature review

目的 探讨成人小脑毛细胞黏液型星形细胞瘤(PMA)的临床特点、手术治疗、放化疗干预及其预后。方法 回顾分析新疆医科大学第一附属医院神经外科2021年4月收治的1例成人小脑半球PMA的临床资料,并结合相关文献进行复习。手术方法采用旁正中入路肿瘤次全切,术后复发给予贝伐单抗化疗干预。结果 患者头颅核磁共振成像(MRI)示右侧小脑半球及脑干偏右缘团状异常占位。术后病理结果显示细胞黏液型星形细胞瘤。术后同步放化疗干预,患者术后7个月复发,规律2周期贝伐单抗治疗后无明显进展,再次复查MRI示肿瘤体积明显减少,行第3周期化疗,术后1年随访临床症状无明显进展。结论 成人小脑PMA罕见,手术以全切为目标,无法全切术后应及时放化疗干预,贝伐单抗治疗有效。

Objective To investigate the clinical features,surgical treatment,radiochemotherapy and prognosis of adult cerebellar pilomyxoid astrocytomas(PMA).Methods The clinical data of an adult with cerebellar hemisphere PMA admitted to the Department of Neurosurgery,the First Affiliated Hospital of Xinjiang Medical University were analyzed retrospectively.The related literature were reviewed.The surgical method adopted a paramedian approach for subtotal resection of the tumor,and bevacizumab chemotherapy intervention was given for postoperative recurrence.Results The magnetic resonance imaging(MRI) showed abnormal mass in the right cerebellar hemisphere and right edge of the brainstem.Postoperative pathological results showed cellular PMA.After concurrent chemoradiotherapy intervention after operation,the patient relapsed 7 months after operation.After regular 2-cycle bevacizumab treatment the patient's symptoms did not progress significantly,and the MRI tumor volume was significantly reduced after re-examination,and a 3-cycle chemotherapy was given again.There was no significant progress in clinical symptoms during the 1-year follow-up.Conclusions Adult cerebellar PMA is extremely rare.The goal of surgery is total resection.If total resection cannot be achieved,radiotherapy and chemotherapy should be intervened in time.Bevacizumab treatment is effective.