成人丘脑恶性胶质瘤手术治疗

摘要

Objective The clinical characteristics and microsurgical treatment of adult unilateral thalamic glioma were investigated.Methods The clinical characteristics of 16 cases and the different approaches for surgery were analyzed,respectively.Diffusion Tensor Imaging (DTI) functional magnetic navigation was used in 10 patients.Subsequent chemoradiotherapy was applied in 15 cases post-operatively.Results Total resection of the tumor was achieved in 15 cases (94％) and subtotal resection in 1 case (6％).Post-operative improvement was achieved in 9 cases (56％) and unchanged in 7 cases (44％).Partial motor aphasia occurred in 1 case.Absence seizure occurred in 1 case.There was no surgery-related death.Ventriculoperitoneal shunt was performed in 2 cases of hydrocephalus;stereotactic puncture was performed in 1 case of post-operative tension effusion.The pathological examination confirmed 15 cases of Grade Ⅲ～ Ⅳ gliomas and 1 case of Grade Ⅱ glioma.Recurrence was occurred in 5 of 15patients (except 1 case) with subsequent chemoradiotherapy (3 ～ 16 months,average 9.8 months).Three patients died because of recurrence (survival time:13 ～20 months,average 17 months).Follow-up survival rate of 1 year and 2 years were 100％ and 81.0％,respectively.Progression free survival of 1 year and 2 year were 75.0％ and 62.5％,respectively.Conclusion It makes the morbidity and mortality of maximal surgical resection for patients with thalamic glioma decrease significantly due to the development of microsurgical technique and neuronavigation.It is the best choice for patients with thalamic glioma to perform maximal surgical resection and subsequent chemoradiotherapy.%目的 探讨成人单侧丘脑胶质瘤的临床特点及显微外科治疗.方法 总结16例丘脑肿瘤的临床特点,结合肿瘤位置分别采用多种入路切除肿瘤.10例患者术中行弥散张量成像功能核磁导航辅助,15例患者术后早期放化疗.结果 肿瘤全切15例(94％),近全切1例(6％).术后1 w改善患者9例(56％);如故患者7例(44％).术后失神发作1例,部分运动性失语1例,无手术直接死亡.2例术后脑积水行脑室-腹腔分流术,1例术后张力性积液行立体定向穿刺术.病理15例Ⅲ～Ⅳ级,1例Ⅱ级.随访14～ 28个月(平均17.9个月),目前除1例未早期放化疗患者复发外,余15例患者中有5例复发,时间为术后3 ～16个月,平均9.8个月,其中3例已经死亡(存活13～20个月,平均17个月),均为肿瘤复发播散.1年存活率100％,1年无进展生存75.0％,2年存活率81.0％,2年无进展生存62.5％.结论 显微外科技术进步结合神经导航技术的发展,使得手术最大范围切除丘脑胶质瘤病残率及死亡率已明显降低,丘脑胶质瘤治疗首选最大范围手术切除,术后应辅以必要的放疗和化疗等综合治疗.