Brainstem Gliomas: Surgical indications and technical considerations in a series of 58 cases
Brainstem Gliomas: Surgical indications and technical considerations in a series of 58 cases
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DOI：
10.3109/02688697.2013.829562
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发表时间：
2014-04-01
影响因子：
1.1
通讯作者：
Sharma, Bhawani S.
中科院分区：
文献类型：
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作者：
Sinha, Sumit;Kale, Shashank Sharad;Sharma, Bhawani S.
目标.目的分析脑干胶质瘤（BSG）的手术指征、手术治疗策略及术后疗效。方法.在1998年至2012年进行的这项回顾性研究中，入组了58例手术治疗的内源性BSG患者，符合入选标准。男40例，女18例，年龄3 ~ 55岁。最常见的表现是步态障碍，无论是由于小脑受累或运动无力，其次是运动无力，眼部受累和头痛。后入路42例，小脑上幕下入路4例.后外侧肿瘤经乳突后入路10例，腹外侧肿瘤经颞下入路4例。结果90%以上的患者神经功能改善，5%的患者神经功能恶化。毛细胞型星形细胞瘤是最常见的组织病理学类型（41.4%），其次是II级星形细胞瘤（34.5%）和III级星形细胞瘤（24.1%）。总体而言，19%的患者发生术后并发症，3例患者（5%）在围手术期死亡。结论.对于边界清楚、位于后方、后外侧和腹外侧、进展缓慢且运动能力相对保留的肿瘤患者，建议手术治疗。BSG凭借外科医生的经验和现代手术设备可以获得良好的手术效果。
Objectives. To analyze the indications of surgical treatment, surgical management strategies and post-surgical outcome in patients with brainstem glioma (BSG). Methods. In this retrospective study conducted from 1998 to 2012, 58 patients of surgically treated intrinsic BSG, meeting the inclusion criterion were enrolled. There were 40 males and 18 females, with age range varying from 3 to 55 years. The most common presentation was gait disturbances, either due to cerebellar involvement or motor weakness, followed by motor weakness, ocular involvement and headache. The posteriorly located tumors were operated by midline suboccipital approach (42 patients) and supracerebellar - infratentorial approach (4 patients). Posterolaterally located tumors were operated by retromastoid (10 patients) and all the ventrolateral tumors by subtemporal approach (4 patients). Results. Above 90% patients improved in their neurological status, while 5% deteriorated. Pilocytic astrocytoma was the most common histopathology (41.4%), followed by Grade II astrocytoma (34.5%) and Grade III astrocytoma (24.1%). Overall, 19% patients had postoperative complications and three patients (5%) died in the perioperative period. Conclusions. Surgery is advocated for patients with well delineated, posteriorly, posterolaterally and ventrolaterally located tumors having slow progression and relative preservation of motor power. BSG can have excellent surgical results with surgeon's experience and modern surgical facilities.