Pathologic Findings and Clinical Course of Midline Paraventricular Gliomas Diagnosed Using a Neuroendoscope
Pathologic Findings and Clinical Course of Midline Paraventricular Gliomas Diagnosed Using a Neuroendoscope
复制标题
DOI：
10.1016/j.wneu.2018.02.185
复制
发表时间：
2018-06-01
影响因子：
2
通讯作者：
Kohno, Michihiro
中科院分区：
文献类型：
--
作者：
Fukami, Shinjiro;Nakajima, Nobuyuki;Kohno, Michihiro
前言：中线侧脑室旁胶质瘤定位深、侵袭性强，手术切除困难，病理诊断需要活检。方法：对26例经神经内窥镜诊断为中线脑室旁胶质瘤的患者进行回顾性研究。病变部位主要为丘脑(11例)、顶盖(6例)和其他部位(9例)。26例患者中，21例(81%)合并梗阻性脑积水。手术是通过侧脑室使用灵活的显微镜进行的。对于梗阻性脑积水的患者，我们增加了内窥镜下第三脑室造口、隔造口和/或Monro孔成形术。结果：病理诊断为I级5例，II级3例，III级6例，IV级4例。6例患者被诊断为高级别胶质瘤，难以区分III级和IV级。2例患者无法诊断。H3-K27M在15例高级别胶质瘤中8例呈强阳性表达。所有高级别胶质瘤患者术后2年内死亡或接受最佳支持治疗。结论：神经内窥镜手术在梗阻性脑积水的治疗以及病理诊断和基因分析方面对中线侧室旁胶质瘤是有用的，符合世界卫生组织2016年的分类要求。
INTRODUCTION: Removal of midline paraventricular gliomas is difficult because of their deep localization and invasive character, requiring biopsy for pathologic diagnosis. This study aimed to assess the pathologic findings and clinical course of midline paraventricular gliomas diagnosed using a neuroendoscope.METHODS: This study was performed as a retrospective investigation using a neuroendoscope of 26 patients whose tumors were diagnosed as midline paraventricular gliomas. The main loci of the lesions were the thalamus (11 patients), tectum (6 patients), and other areas (9 patients). Of these 26 patients, 21 (81%) had accompanying obstructive hydrocephalus. Surgery was performed via the lateral ventricle using a flexible scope. For patients with obstructive hydrocephalus, we added endoscopic third ventriculostomy, septostomy, and/ or plasty of the foramen of Monro. Pathologic diagnosis was determined according to hematoxylin-eosin staining and immunohistochemistry using anti-GFAP, anti-Ki-67, anti-H3-K27M, and anti-IDH1-R132H antibodies.RESULTS: The pathologic diagnoses were grade I (5 patients), grade II (3 patients), grade III (6 patients), and grade IV (4 patients) gliomas. Six patients were diagnosed as having high-grade glioma, which was difficult to distinguish between grade III and grade IV. Two patients were undiagnosable. H3-K27M was strongly positive in 8 of 15 patients with high-grade glioma. All patients with high-grade gliomas died or received best supportive care within 2 years after surgery.CONCLUSIONS: Neuroendoscopic surgery is useful for midline paraventricular gliomas in terms of the treatment of obstructive hydrocephalus, as well as pathologic diagnosis and genetic analysis, which are required under the World Health Organization 2016 classification.