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目的:探讨松果体区肿瘤的治疗策略。方法:我院自2003年12月至2007年12月收治的58例松果体区肿瘤,按肿瘤标志物甲胎蛋白(AFP)和人β-促绒膜性腺激素(hCG-β)将其分为标志物增高组和正常组,回顾分析两组临床资料和治疗体会。结果:肿瘤标志物正常组36例,其中27例行手术切除肿瘤,9例行伽马刀治疗(其中5例行伽马刀加脑室腹腔分流治疗)。术后4例因病理报告示生殖细胞瘤行伽马刀补充治疗,3例因梗阻性脑积水行脑室腹腔分流。增高组22例,均选用伽马刀治疗(其中17例合并梗阻性脑积水者行伽马刀加脑室腹腔分流)。治疗后3例因症状缓解不佳行手术切除肿瘤术。手术病例中24例采用经胼胝体入路,4例经枕部小脑幕入路,2例经幕下小脑上入路。手术全切24例,次全切5例,部分切除1例,术后住院期内死亡者1例。病理诊断:生殖细胞瘤14例,畸胎瘤5例,中枢神经细胞瘤4例,室管膜瘤2例,表皮样囊肿2例,脑膜瘤1例,胶质瘤1例,皮样囊肿1例。放射外科治疗病例中28例术后3个月临床症状明显改善,4例随访期内肿瘤无明显变化,3例肿瘤增大。2例放疗后出现鞍区转移。结论:松果体区肿瘤组织类型多样,应尽可能先明确肿瘤性质后选择合理治疗策略。
Objective: To explore the treatment strategy of pineal region tumors. Methods: From December 2003 to December 2007, 58 cases of pineal region tumors were treated with AFP and hCG-β Divided into markers increased group and normal group, retrospective analysis of two groups of clinical data and treatment experience. Results: The tumor markers were normal in 36 cases, of which 27 cases underwent surgical resection of the tumor and 9 cases were treated with gamma knife (5 of them were treated with gamma knife and ventriculoperitoneal shunt). After surgery, 4 patients were treated with Gamma knife to treat germinoma due to pathological report, and 3 patients had peritoneal shunt due to obstructive hydrocephalus. Twenty-two patients in the elevated group were treated with Gamma Knife (17 patients with obstructive hydrocephalus underwent gamma knife plus ventriculoperitoneal shunt). After treatment, 3 patients underwent surgical resection of the tumor due to poor symptom relief. Twenty-four patients underwent transcallosal approach, 4 underwent transcortical cerebellar approach, and 2 underwent supratentorial cerebellar approach. In the operation, 24 cases were completely cut, 5 cases were subtotectically cut, and 1 case was partially resected. One patient died after hospitalization. Pathological diagnosis: germ cell tumor in 14 cases, teratoma in 5 cases, 4 cases of central neurocytoma, 2 cases of ependymoma, 2 cases of epidermoid cysts, 1 case of meningioma, 1 case of glioma, dermoid cysts 1 example. In the radiosurgery group, the clinical symptoms of 28 cases were significantly improved 3 months after operation. No significant changes were found in the 4 cases during the follow-up period, and the tumor size was increased in 3 cases. 2 cases of metastasis after radiotherapy metastasis. Conclusion: There are many types of tumor tissues in pineal region, and the reasonable treatment strategy should be selected as soon as possible after the tumor characteristics are clear.