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。
Citation:
MOU Kejie,MAO Qing,LIU Yanhui. Treatment Strategies of the Pineal Region Tumors. West China Medical Journal, 2009, 24(1): 14-17. doi:
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Konovalov AN,Pitskhelaur DI.Principals of treatment of the pineal region tumors[J].Surg Neurol,2003,59(4):250-268..
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Oi S,Kamio M,Joki T,et al.Neuroendoscopic anatomy and surgery in pineal region tumors:role of neuroendoscopic procedure in the ‘minimallyinvasive preferential’ management[J].J NeuroOncol,2001,54(3):277-286..
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Chernov MF,Kamikawa S,Yamane F,et al.Neurofiberscopic biopsy of tumors of the pineal region and posterior third ventricle:indications,technique,complications,and results[J].Neurosurgery,2006,59(2):267-277..
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- 1. Grossman RG,Lxjfius CM.王任直主译.Principles of Neurosurgery[M].北京:人民卫生出版社,2002:437-443..
- 2. Gerhard P.Management of pineal region tumors[J].Neurosurg Q,2002,12(4):279-298. [3]Araki C,Matsumoto S.Statistical reevaluation of pinealoma and related tumors in Japan[J].J Neurosurg,1969,30:146-149..
- 3. Sano K.Diagnosis and treatment of tumors in the pineal region[J].Acta Neurochir (Wien),1976,34:153-157..
- 4. 王立根,郭艳,章翔,等.立体定向放射神经外科治疗松果体区肿瘤[J].立体定向和功能性神经外科杂志,2001,14(2):86-88..
- 5. Friedman WA,Foote KD.Linear accelerator radiosurgery in the management of brain tumors[J].Ann Med,2000,32:64..
- 6. 漆松涛,张喜安,潘军.显微手术切除松果体区肿瘤(附34例报告)[J].中国神经精神疾病杂志,2003,29(4):265-268..
- 7. Oi S.Recent advences and racial diferences in therspeutic strategy to the pineal region tumor[J].Childs Nerv Syst,1998,14(12):33-35..
- 8. 梁树立.松果体区肿瘤的外科治疗[J].国外医学神经病学神经外科学分册,2001,28(3):149.
- 9. 〖ZK(#〗Fauchon F,Jouvet A,Paquis P,et al.Parenchymal pineal tumors:a clinicopathological study of 76 cases[J].Int J Radiat Oncol Biol Phys,2000,46(4):959-968..
- 10. Kang JK,Jeun SS,Hong YK.Experience with pineal region tumors[J].Childs Nerv Syst,1998,14(12):63-68..
- 11. Bruce JN,Ogden AT.Surgical strategies for treating patients with pineal region tumor[J].J Neurooncol,2004,69(13):221-236..
- 12. Konovalov AN,Pitskhelaur DI.Principals of treatment of the pineal region tumors[J].Surg Neurol,2003,59(4):250-268..
- 13. Pople IK,Athanasiou TC,Sandeman DR,et al.The role of endoscopic biopsy and third ventriculostomy in the management of pineal region tumors[J].Br J Neurosurg,2001,15(4):305-311..
- 14. Oi S,Kamio M,Joki T,et al.Neuroendoscopic anatomy and surgery in pineal region tumors:role of neuroendoscopic procedure in the ‘minimallyinvasive preferential’ management[J].J NeuroOncol,2001,54(3):277-286..
- 15. Chernov MF,Kamikawa S,Yamane F,et al.Neurofiberscopic biopsy of tumors of the pineal region and posterior third ventricle:indications,technique,complications,and results[J].Neurosurgery,2006,59(2):267-277..
- 16. Pople IK,Athanasiou TC,Sandeman DR,et al.The role of endoscopic biopsy and third ventriculostomy in the management of pineal region tumors[J].Br J Neurosurg,2001,15(4):305-311.