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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。
Early glioma near the central groove can cause limb dysfunction, seriously affecting the quality of life of patients, this paper aims to explore how to improve the surgical treatment of glioma near the Central Groove to improve the quality of life. Methods: The clinical manifestations, diagnosis, selection of operative methods, treatment outcome and prognosis of 84 glioma patients treated in our department from 1995 to 2001 were retrospectively reviewed. Results: In 84 cases of gliomas, the tumor was located in 36 cases before the Central Gully, 30 cases in the Central Gully, and the main body was located in 18 cases below the Central Gully. Clinical onset of symptoms of epilepsy in 59 cases of progressive limb weakness or numbness in 15 cases, headache and other symptoms of increased intracranial pressure as the main manifestation of onset in 10 cases. Postoperative pathological classification by WHO, prompted astrocytic tumors in 58 cases, 20 cases of oligodendrocyte tumors, oligodendrocytes and astrocytomas mixed tumor in 6 cases. Astrocytoma in astrocytoma: 6 cases, astrocytoma in 29 cases, glioblastoma in 23 cases; oligodendroglioma in oligodendroglioma in 6 cases, anaplastic oligodendrocytes Stromal cell tumors in 14 cases. Total resection of the tumor under microscope in 67 cases, subtotal resection in 17 cases. Postoperative limb dysfunction was reduced 20 cases compared with preoperative, unchanged in 22 cases, short-term exacerbation and limb function recovery after 12 cases, aggravating 30 cases, no operative death. CONCLUSIONS: To fully understand the anatomic location of the tumor and the adjacent structures of the surrounding structures before surgery, microsurgical techniques to remove tumors in the subretinal space and to protect the anatomy and function of the central ditch veins are the key to the operation.