Diffusion tensor imaging of intraaxial tumors at the cervicomedullary and pontomedullary junctions - Report of two cases
Diffusion tensor imaging of intraaxial tumors at the cervicomedullary and pontomedullary junctions - Report of two cases
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DOI：
10.3171/ped.2005.103.6.0557
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发表时间：
2005-12-01
影响因子：
4.1
通讯作者：
Ogg, RJ
中科院分区：
文献类型：
--
作者：
Phillips, NS;Sanford, RA;Ogg, RJ
脑干胶质瘤是一组异质性病变，占所有儿童中枢神经系统肿瘤的15%。这些肿瘤的诊断和治疗计划是基于Epstein和Fanner的观察，即低恶性潜能的病变的生长受到脑干解剖结构的限制。手术只提供给那些低级别肿瘤的高概率患者，因为伴随而来的显著发病率风险超过了在高级别肿瘤病例中去除肿瘤的治疗益处。作者报告了两个病例，突出了弥散张量(DT)成像在识别桥脑、延髓和颈髓局部白质束以及改善低级别胶质瘤的术前评估方面的潜力。这两个病例的术前DT影像显示，白质束被大部分低级别肿瘤移位，但结构上保持不变。术中和神经学发现与术前DT图像的解释一致。这些病例表明，DT成像是可视化肿瘤与正常脑干白质结构之间的关系以及改善儿童脑干肿瘤的外科评估和处理的有用方法。
Brainstem gliomas are a heterogeneous group of lesions that account for 15% of all pediatric tumors of the central nervous system. Diagnosis and treatment planning for these tumors is based on the observation of Epstein and Fanner that the growth of lesions with low malignant potential is limited by the anatomical structures of the brainstem. Surgery is offered only to those patients with a high probability of harboring a low-grade tumor, because the attendant risk for significant morbidity outweighs the therapeutic benefit of debulking the tumor in cases of high-grade tumors.The authors report two cases that highlight the potential of diffusion tensor (DT) imaging to identify local white matter tracts in the pons, medulla, and cervical cord and to improve the preoperative assessment of low-grade gliomas. Preoperative DT imaging in both cases demonstrated that the white matter tracts were displaced by the bulk of the low-grade tumors but were structurally preserved. Intraoperative and neurological findings were consistent with the preoperative interpretation of the DT images. These cases demonstrate that DT imaging is a useful method for visualizing the relationship between tumor and normal brainstem white matter architecture, as well as for improving the surgical evaluation and management of pediatric brainstem tumors.