摘要
目的探讨儿童视路胶质瘤的临床特点、治疗及预后。方法回顾性分析2016年1月至2019年8月首都医科大学附属北京儿童医院神经外科收治的、并经病理学证实的32例儿童视路胶质瘤患儿的临床资料。32例患儿均行开颅手术治疗,其中19例采用经纵裂入路,11例采用经胼胝体-穹窿间入路,1例采用经翼点入路,1例采用经右额叶皮质造瘘入路。其中应用弥散张量成像技术结合术中神经导航辅助手术16例。术后定期行临床及影像学随访,以观察患儿的预后情况。结果32例儿童视路胶质瘤患儿的中位就诊年龄为2岁(6个月至9岁6个月)。其中22例有眼科症状,16例有颅高压症状,6例出现极度消瘦。肿瘤近全切除8例,大部切除21例,部分切除3例。术后病理学检查结果显示,毛细胞型星形细胞瘤9例,毛细胞黏液样星形细胞瘤23例。术后1例行化疗辅助放疗,4例单纯行放疗,23例单纯行化疗,余4例患儿术后未行化疗和放疗。32例患儿的中位随访时间为1.4年(2个月至4年),其中6例患儿术后出现肿瘤进展,死亡2例。结论儿童视路胶质瘤患儿的临床表现以眼科症状为主,可伴有颅高压症状,部分患儿表现为极度消瘦;治疗应采取手术和放化疗相结合的综合治疗方式;术后多数患儿预后良好,但应注意保证患儿的生存质量。
Objective To explore the clinical features,diagnosis and therapeutic strategies of pediatric optic pathway gliomas.Methods A retrospective analysis was conducted on the clinical data of 32 pediatric patients of pathologically confirmed optic pathway glioma who were treated at Neurosurgery Department of Beijing Children’s Hospital,Capital Medical University between January 2016 and August 2019.All patients underwent craniotomy,which was performed through the longitudinal fissure approach in 19 cases,transcallosal interforniceal approach in 11,pterygium approach in 1,and right frontal cortex fistula approach in 1.Among them,diffusion tensor imaging(DTI)combined with intraoperative navigation was employed in 16 cases during operation.Regular clinical and imaging follow-up was performed to assess the outcome of the patients post operation.Results The median age of 32 children at admission was 2 years(6 months to 9 years and 6 months)old,of whom 22 had ophthalmic symptoms,16 had intracranial hypertension symptoms,and 6 had emaciation.Gross total resection of the tumor was achieved in 8 cases,subtotal resection in 21 and partial resection in 3.Postoperative pathological results indicated 9 cases of pilocytic astrocytoma and 23 cases of pilomyxoid astrocytoma.Post operation,1 patient underwent chemotherapy-assisted radiotherapy,4 underwent radiation therapy alone,23 patients underwent chemotherapy,and 4 patients did not undergo chemotherapy and radiotherapy.The median follow-up time of 32 patients was 1.4 years which ranged from 2 months to 4 years.Tumor progression was reported in 6 patients and 2 died.Conclusions The clinical manifestations of children with optic pathway gliomas are mainly ophthalmological symptoms,which may be accompanied by cranial hypertension symptoms,and some children show severe wasting.Treatment should combine surgery with radiotherapy and chemotherapy.Most postoperative children seem to have good outcomes,while care should be taken to ensure the quality of life of the child.
作者
王佳
葛明
张天蕾
彭芸
程华
施维
张楠
李少武
冀园琦
孙骇浪
Wang Jia;Ge Ming;Zhang Tianlei;Peng Yun;Cheng Hua;Shi Wei;Zhang Nan;Li Shaowu;Ji Yuanqi;Sun Hailang(Department of Neurosurgery,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China;Department of Medical Imaging,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China;Department of Ophthalmology,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China;Department of Pathology,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China;Beijing Institute of Neurosurgery,Capital Medical University,Beijing 100070,China)
出处
《中华神经外科杂志》
CSCD
北大核心
2020年第6期545-549,共5页
Chinese Journal of Neurosurgery
基金
首都临床特色应用研究项目(Z16110700050000)。
