Direct surgery for brainstem tumours.
Direct surgery for brainstem tumours.
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脑干肿瘤的直接手术。
DOI：
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发表时间：
1991
期刊：
影响因子：
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通讯作者：
A. Talacchi
中科院分区：
文献类型：
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作者：
Albino Bricolo;S. Turazzi;L. Cristofori;A. Talacchi
更新先前的报告，作者提供了45例年龄在2至63岁之间的患者直接手术切除脑干肿瘤的各种描述的回顾。自1986年以来，除CT扫描外，所有候选患者均接受核磁共振成像检查，有时还进一步增加数字减影椎动脉造影。根据Epstein和McLeary的标准，24例肿瘤为局灶性，12例为颈髓性，9例为弥漫性。组织学诊断以胶质瘤居多（36例介于低级别星形细胞瘤、间变性星形细胞瘤和胶质母细胞瘤之间）；其余为海绵状瘤（6例）、血管母细胞瘤（2例）和脂肪瘤（2例）。28例患者实现了大体全切除，包括所有的室管膜瘤或血管肿瘤，以及17例低级别星形细胞瘤中的14例。16例手术切除部分，1例手术切除部分。无手术死亡，术后早期死亡2例。出院时，35例患者神经系统状况无变化或改善。随访3个月，改善12例，无变化27例，恶化3例。到1990年1月（术后6至72个月），首批40例患者中有27例存活：13例恢复正常生活，6例自给自足，8例残疾。作者得出结论，目前轴内脑干肿瘤的显微手术切除与低死亡率和发病率相关，并提供了良好的结果，他们将其归功于高质量的核磁共振成像，有效的显微手术，充分的麻醉和合格的术后重症监护。
Updating a previous report, the authors offer a review of 45 patients between age 2 and 63 treated by direct surgical excision for brainstem tumours of various description. Since 1986 all candidate patients were examined by NMR imaging in addition to CT scanning, sometimes with the further addition of digital-subtraction vertebral angiography. By Epstein and McLeary's criteria, 24 of the tumours were focal, 12 were cervicomedullary and 9 were diffuse. The most frequent histological diagnosis was glioma (36 cases between low-grade astrocytoma, anaplastic astrocytoma and glioblastoma); the balance was provided by cavernoma (6 cases), haemangioblastoma (2 cases), and lipoma (2 cases). Gross total resection was achieved in 28 patients, namely all those with ependymoma or vascular tumours and 14 of 17 with low-grade astrocytoma. Resection was subtotal in 16 cases and confined to a generous biopsy in one. There was no operative mortality, but 2 deaths occurred in the early postoperative period. At discharge, neurological status was unchanged or improved in 35 cases. At 3-month follow-up examination, 12 patients were improved, 27 were unchanged and 3 were worsened. By January 1990 (6 to 72 months postoperatively) 27 of the first 40 patients treated were alive: 13 had resumed normal life, 6 were self-sufficient and 8 were disabled. The authors conclude that present-day microsurgical resection of intra-axial brainstem tumours is associated with low mortality and morbidity and affords favourable results for which they credit high-quality NMR imaging, efficient microsurgery, adequate anesthesia, and competent postoperative intensive care.