脑神经胶质瘤病的诊断和治疗
脑神经胶质瘤病的诊断和治疗
更新日期： 12-07 #e#
【关键词】 诊断
【摘要】 目的 探讨脑神经胶质瘤病的临床特征及其诊断与治疗。方法 回顾性分析9例经开颅手术或定向活检证实为脑神经胶质瘤病的临床表现、影像学资料及治疗效果。结果 9例均有颅内高压表现，CT扫描共发现23个病灶，其中病灶累及3个脑叶者5例，累及2个脑叶者4例。CT平扫病灶呈高密度5个，等密度5个，低密度13个，大多数病灶强化不明显，瘤周轻中度水肿。4例行MRI检查发现胼胝体肥大2例。9例均获得6个月以上随访。结论 脑神经胶质瘤病CT扫描易误诊为转移瘤，MRI扫描对脑神经胶质瘤病的诊断有一定的价值，确诊有待于病理检查。手术切除程度是决定预后的重要因素，术后分割放疗是控制肿瘤生长及延迟复发的重要辅助治疗手段。
【关键词】 肿瘤，神经上皮；诊断；治疗
Diagnosis and treatment of cerebral glioma
【Abstract】 Objective To investigate the clinical features,diagnosis and treatment of cerebral glioma.Methods Retrospective analysis was conducted in view of the clinical manifestation,imaging information and therapeutric results of 9 patients with cerebral glioma confirmed by pathological examination after operation or oriented biopsy.Results All 9 cases had symptoms of intracranial hypertension,and 23 foci were located with CT scanning,5 foci in higher density,5 foci in equal density and 13 foci in lower density.No enhancement demonstrated in 8 foci,and slight or moderate enhancement in 15 foci.All foci hand paratumoral edema at different degrees.The foci involved 3 lobes in 5 cases,and 2 lobes in 4.MRI examination showed hypertrophy of corpus callosum in 2 cases.All 9 cases were followed up for more than half a year.Conclusion Cerebral glioma is prone to be misdiagnosed as metastatic tumor by CT,MRI scanning is valuable for the diagnosis.Confirmed diagnosis depends on pathological examinantion.The degree of operational incision is an important factor affecting prognosis and postoperative assistant radiotherapy is important to inhibit the growth of tumor and postphone the recurrence of tumor.
【Key words】 neoplasms,neuroepithelia;diagnosis;treatment
WHO将侵犯2~3个脑叶弥散浸润的胶质瘤归类为大脑神经胶质瘤病（cerebral glioma,CG）。CG是一种罕见的中枢神经系统原发性肿瘤，临床表现无特异性，神经影像学也缺乏特征性，确诊主要依靠病理学检查。我院于1986~2001年10月共收治CG患者9例，通过回顾性分析及复习相关文献，对该病的诊断与治疗有一定的认识，现报告如下。
1 资料与方法
1.1 一般资料 本组9例，男7例，女2例，年龄18~48岁。病程12天~3个月。临床表现：头痛伴恶心呕吐8例，癫痫大发作1例，局限性发
作1例，肢体运动障碍6例，运动性失语3例，视乳头水肿6例。腰穿压力250~300mmH2O 6例，＞300mmH2O 3例。
1.2 影像学检查 9例均行CT检查，其中4例同时行MRI检查。共发现病灶23个，额叶3个，额顶叶5个，顶叶2个，顶枕叶4个，颞枕叶1个，基底节区2个，胼胝体1个，松果体区1个，侧脑室前角周围1个，脑室系统内3个，其中病灶累及3个脑叶者5例、累及2个脑叶者4例。CT平扫病灶呈高密度5个，等密度5例，低密度13个，同一例中病灶密度不同者5例，病灶密度相似者4例，不强化病灶8个，轻中度强化12个，所有病灶周围均有不同程度水肿。4例行MRI检查发现胼胝体肥大2例。
1.3 治疗 9例均行开颅手术，全切除病灶12个，部分切除病灶4个，活检病灶7个。其中3例一次性全切除所有病灶，2例全切除1个病灶，其余病例与病灶仅部分切除或行立体定向活检。7例手术后行普通分割放疗，1例脑室内肿瘤行后装治疗。
1.4 病理诊断 星形细胞瘤Ⅰ~Ⅱ级4例，Ⅱ~Ⅲ级2例，Ⅲ级1例，胶质细胞瘤伴血管瘤1例，间变性室管膜瘤1例。