【作者】 胡国章；

【导师】 田宇；

【作者基本信息】 吉林大学 ， 外科学， 2008， 硕士

【摘要】 颅内多发性胶质瘤在临床上比较少见,在诊断上与多发性脑转移瘤、多发脑脓肿等很多疾病很难鉴别,最后确诊还要依赖组织病理学结果。立体定向活检为颅内多发性胶质瘤的诊断提供了重要的诊断方法。我们从经CT或MRI引导下行立体定向活检1049例患者中,选取病理结果为颅内多发性胶质瘤的17例患者。17例患者都得出了明确的阳性病理诊断。其中:星形细胞瘤Ⅰ级1例,星形细胞瘤Ⅰ-Ⅱ级1例,星形细胞瘤Ⅱ级5例,星形细胞瘤Ⅱ-Ⅲ级4例,星形细胞瘤Ⅲ级2例,少突胶质细胞瘤1例,多形性胶质母细胞瘤1例,胶质母细胞瘤4例。其中多灶性脑胶质瘤15例,多中心性脑胶质瘤2例。全组17例患者中,13例患者在手术中或术后给予相应的治疗,其中¹²⁵Ⅰ籽粒植入治疗9例;伽玛刀放射治疗2例;全脑放疗结合化疗1例;化疗1例,放弃治疗4例。全组17例患者总体平均生存期为7个月（2-18个月）,其中生存期3个月以下的1例;生存期3-6个月以下的5例;生存期6-12个月的8例;生存期12个月以上的3例。其中多灶性脑胶质瘤平均生存期为7.9个月,多中心性脑胶质瘤平均生存期为3.5个月。结合本组临床数据总结和以往文献报道得出以下结论:立体定向活检是脑深部占位性病变定性诊断的重要手段;立体定向活检是确定复杂颅内病变,如颅内多发性胶质瘤病理诊断的必要方法;颅内多发性胶质瘤常见于中老年人;影响学上以长T1、长T2为主,增强后强化明显,占位效应明显;预后较差,平均生存期为7个月。更多还原

【Abstract】 Objective:Multiple gliomas are not frequently seen in clinics.They could be misdiagnosed as metastatic brain tumors,multiple abscess or other cerebral diseases.A definite diagnosis of multiple gliomas should be confirmed by histopathological examination.Stereotactic biopsy represents a safe and satisfactory method for achieving sure diagnosis for intracranial lesions.It has become a powerful and safe tool for providing tissue samples for diagnosis with minimal disruption of normal brain function,and plays a significant role in the diagnosis of intracranial lesions.Despite the diagnosis rate of intracranial lesions has been greatly improved with the progress of imaging technology, there are still some brain lesions particularly deep or multiple lesions can not be determined only by the combination of radio image and clinical manifestations, the definite diagnosis should be confirmed by histopathological examination. Because the clinical manifestations and radioimage features of multiple gliomas are not typical,the final diagnosis should depend on histopathological diagnosis.In present,how to improve the diagnosis rate of multiple gliomas is a hot and difficult tissue.Despite there are some progresses concerning the classification and pathogenesis,there are seldom literatures which focus on the diagnosis of multiple gliomas.To investigate the role of stereotactic biopsy for pathological diagnosis of multiple gliomas,meanwhile explore the clinical manifestations,diagnosis methods,therapy and prognosis of multiple gliomas.We selected patients with multiple gliomas confirmed by stereotactic biopsy by screening the data of 1039 patients diagnosed by stereotactic biopsy in The Navy General Hospital of PLA from 1988 to 2007 and 10 patients diagnosed by stereotactic Clinical in Chinese-Japan Union Hospital of Jilin University from January 2005 to December 2007.17 cases have been choosed.And clinical data of the 16 cases are analyzed retrospectively.Methods:All the 17 cases were underwent CT/MRI-guided stereotactic biopsies.All the procedures were done under local anesthesia with CT or MRI guided stereotactic system.The "four point-one line" hand count method and Computer-assisted Planning for Neurosurgery was used to determine the coordinate.The specimens obtained from stereotactic biopsy were underwent pathological exam.Of the 17 cases,one target was selected in 13 cases,and two targets were selected in other 4 cases.Results:Thus far,in foreign literature,there were 3 papers having reporting 18 cases with multiple gliomas diagnosed by stereotactic biopsy;In Chinese literature,there were 5 papers having reporting 25 cases.In our study, 17 cases with multiple gliomas were diagnosed by CT or MRI guided stereotactic biopsy.Of the 17 cases,11 were male and 6 were female.The ratio of male to female was 1.8:1.Age at presentation of GC ranged from 30 years to 75 years(.median,49.2 years).Main symptoms:headache(9 cases),epilepsy(7 cases),limb weakness(6 cases),with two cases of disturbance of consciousness. Finding on neurological examination included pyramidal tract impairment(10 cases),the reaction retardation or dementia(2 cases),decreased visual acuity(1 cases),and visual field defect(1 cases).Of the 17 cases,there were 12 cases of astrocytoma(WHO I,1 cases;WHOⅠ-Ⅱ,1 cases;WHOⅡ,5 cases; WHOⅡ-Ⅲ,4 cases;WHOⅡ-Ⅲ,4 cases;WHOⅢ,2 cases),1 case of anaplastic oligodendroglioma and 4 cases of glioblastoma.The median survival is 7months(range from 2 months to 18 months).There are 15 cases of multifocal gliomas,and 2 cases of multicentric gliomas.In patients with multifocal gliomas,the median survival of is 7.9 months.In patients with multicentric gliomas,the median survival of is 3.5 months.Conclusions:1.Stereotactic biopsy is a powerful and safe tool to provide tissue diagnosis for deep brain lesions.2.Stereotactic biopsy represents a safe and reliable method for histological diagnosis of multiple gliomas.3.In our study,the majority of patients with multiple gliomas are of old age.Generally,lesions produce a hypointense signal on T1-weighted images, and a hyperintense signal with T2-weighted images.Edema and mass effects are moderate.Contrast enhancement is most strong.The prognosis is grim,and the median survival is 7months.更多还原