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目的探讨改善侧脑室内脑胶质瘤显微外科手术治疗的策略和方法,提高治疗效果。方法回顾性分析自2000年1月至2007年6月在我院治疗并经病理证实的23例侧脑室脑胶质瘤患者的临床表现、诊断和显微外科手术治疗方式。临床以头痛等颅内压增高为主要症状者15例,以进行性单侧肢体肌力减退起病者4例,以记忆力下降起病者5例,以癫痫起病者2例。根据肿瘤影像学特点和病理性质选择最佳手术入路和综合治疗策略。6例选择经纵裂胼胝体前部入路,5例经额巾同皮层脑室入路,4例经纵裂胼胝体前部联合额叶皮层入路切除前角和体部位置较前的肿瘤,7例经顶叶皮层入路切除三角区及体部位置偏后的肿瘤,1例经枕叶皮层入路切除枕角肿瘤。6例应用术中导航定位,4例应用术中B超监测。术后病理证实为胶质瘤且级别在Ⅱ级以上者行化疗和放疗,化疗方案为卫萌-26+氯乙环已亚硝脲(甲基-CCNU),放疗方案根据胶质瘤病理级别和范围进行个体化设定。采用电话、门诊及邮件等方式进行随访。结果在显微外科治疗的79例侧脑室肿瘤中23例术后病理证实为脑胶质瘤,其中星形细胞瘤11例,少突胶质细胞瘤6例,中枢神经细胞瘤4例,室管膜瘤2例。肿瘤主体位于侧脑室前角和体部15例,位于三角区及后角8例。显微镜下全切除肿瘤15例,次全切除肿瘤6例,部分切除肿瘤2例。术后临床症状改善18例,较术前加重2例,无明显变化3例,因肺部感染并发症死亡1例。随访显示存活1年以上有17例,术后1年内死亡6例。结论侧脑室胶质瘤术前应充分了解肿瘤在侧脑室解剖位置、毗邻关系、血供及是否合并有脑积水等,正确选择手术入路可降低致残率而取得良好疗效。导航辅助或B超实时监测技术结合显微外科手术有助于提高肿瘤的切除程度,采取积极正确的治疗策略可使侧脑室胶质瘤预后得到改善。
Objective To explore the strategies and methods of improving microsurgical treatment of lateral cerebral ventricle glioma and to improve the therapeutic effect. Methods The clinical manifestations, diagnosis and microsurgical treatment of 23 patients with intracerebroventricular gliomas who were treated in our hospital from January 2000 to June 2007 were retrospectively analyzed. Clinical headache and other increased intracranial pressure as the main symptoms in 15 cases, with progressive unilateral limb muscle weakness in 4 cases, 5 cases of memory decline in onset, 2 cases of onset of epilepsy. According to tumor imaging features and pathological properties of the best choice of surgical approach and comprehensive treatment strategy. In 6 cases, the anterior approach was performed through the anterior approach of the corpus callosum in 5 cases, the anterior cortex in the frontal cortex of the corpus callosum in 4 cases and the anterior cortex in 4 cases. Case resection of the cortex and parietal tumors by the parietal cortex approach, 1 case of occipital horn tumor through the occipital cortex approach. 6 cases were applied intraoperative navigation and positioning, and 4 cases were applied intraoperative B-monitoring. Postoperative pathology confirmed as gliomas and grade above grade Ⅱ chemotherapy and radiotherapy, chemotherapy program for Wei Meng -26 + carbachol nitrosourea (methyl-CCNU), radiotherapy program based on glioma pathological grade And the scope of individual settings. By telephone, outpatient and e-mail and other means of follow-up. Results In microsurgical treatment of 79 cases of lateral ventricle tumors in 23 cases of pathological confirmed as gliomas, including 11 cases of astrocytoma, oligodendroglioma in 6 cases, 4 cases of central neurocytoma, room Membranous tumor in 2 cases. Tumor main body located in the anterior horn and body of the lateral ventricle in 15 cases, located in the triangle and posterior horn in 8 cases. Total resection of the tumor under the microscope in 15 cases, subtotal resection of the tumor in 6 cases, partial resection of the tumor in 2 cases. Postoperative clinical symptoms improved in 18 cases, 2 cases worse than preoperative, no significant change in 3 cases, 1 patient died of pulmonary infection complications. Follow-up showed survival for more than 1 year in 17 cases, 6 cases died within 1 year after surgery. Conclusions The preoperative ventricle glioma should know the tumor anatomical location in the lateral ventricle, the adjacent relationship, the blood supply and hydrocephalus or not. Preoperative surgical approach can reduce the morbidity and achieve good results. Navigation aids or B-ultrasound real-time monitoring combined with microsurgery help to improve the tumor resection degree. The positive and correct treatment strategy can improve the prognosis of lateral brain gliomas.