中央沟附近胶质瘤的手术治疗探讨

Diagnosis and Surgical Treatment of Glioma near Central Sulcus

中央沟附近胶质瘤早期即可引起肢体功能障碍,严重影响患者的生活质量,本文旨在探讨如何提高中央沟附近胶质瘤的手术治疗效果,改善生活质量。方法:回顾性总结1995～2001年我科收治的中央沟附近84例胶质瘤的临床表现、诊断、手术方式的选择、治疗结果与预后。结果:84例胶质瘤中,肿瘤主体位于中央沟前36例,位于中央沟后30例,主体位于中央沟下方18例。临床上首发症状为癫痫的59例,以进行性一侧肢体无力或麻木15例,以头痛等颅内压增高症状为主要表现起病的10例。术后病理按WHO分级分类,提示星形细胞肿瘤58例,少突胶质细胞肿瘤20例,少突胶质细胞与星形细胞混合瘤6例。星形细胞肿瘤中星形细胞瘤6例,间变型星形细胞瘤29例,胶质母细胞瘤23例;少突胶质细胞肿瘤中少突胶质细胞瘤6例,间变型少突胶质细胞瘤14例。在显微镜下肿瘤全切除67例,次全切除17例。术后肢体功能障碍较术前减轻20例,不变22例,短期加重而后肢体功能恢复的有12例,加重30例,无手术死亡。结论:术前要充分了解肿瘤的解剖位置和周围结构的毗邻关系,采用显微外科技术在软脑膜下切除肿瘤,保护中央沟静脉解剖和功能的完整,是手术的关键。

[ARSTRACT] BACKGROUND&OBJECTIVE: Glioma near central sulcus remains challenge to neurosur-geon. This paper is to review clinical factors that may lead to improvement in outcome and quality of life of pa-tients with glioma near central sulcus undergoing surgical treatment. METHODS: A retrospective review was conduct-ed on clinical features, diagnosis, the choice of operative approaches and prognosis in a total of 84 cases with glioma near central sulcus between January 1995 and December 2001. RESULTS: Of the 84 patients with glioma, the main bulk of tumor located anterior to the central sulcus in 36 (43%) cases, posterior to the central sulcus in 30 (36%) cases and underneath the central sulcus in other 18 (21%) cases. Initial symptoms were seizures in 59 (70%) cases, progressive unilateral limb weakness in 15 (18%) cases, and symptoms of increased intracranial pressure such as headache in 10 (12%) cases. Pathological pattern results show astrocytic tumors in 58 (69%) cases, oligiodendroglial tumors in 20 (24%) cases, and mixed astrocytic and oligiodendroglial glioma in 6(7%) cases. According to WHO (World Health Organization) classification, there were 6(7%) cases of astrocytoma, 29(35%) cases of anaplasticastrocytoma, 23(27%)cases of glioblas-toma, 6(7%)cases of oligodendroglioma and 14(17%) cases of anaplastic oligodendroglioma. The tumors were totally removed in 67(80%) cases and were subtotally removed in 17(20%) cases. The limb function improved after operation in 20(24%) cases, remained no change in 22(26%) cases, transient deteriora-tion then improved in 12(14%) cases, permanently deteriorated in 30(36%) cases. There was no operative mortali-ty. CONCLUSION: It is essential to understand the anatomical location of the glioma near central sulcus and its relationship with the surrounding structures. Microneurosurgical technique should be used to perform sub-pial re-moval of the tumour. It is critical to anatomically and functionally preserve the central sulcus vein.