摘要
目的总结松果体区生殖细胞瘤合并梗阻性脑积水的治疗经验。方法回顾性分析2016年9月至2019年9月经脑室镜下活检术+第三脑室底造瘘术治疗的15例生殖细胞瘤合并梗阻性脑积水的临床资料。无甲胎蛋白(AFP)升高的病人,术后给予全脑全脊髓放疗(36 Gy)+肿瘤区放疗(42 Gy);存在AFP升高的病人,术后给予全脑全脊髓放疗+EP(顺铂+足叶乙甙)方案化疗。结果15例均成功进行脑室镜下活检术,明确诊断;其中14例第三脑底造瘘成功,1例造瘘不成功改行改行透明隔造瘘+Om⁃maya囊置入术。15例术后随访8~45个月,平均24个月;1例放化疗过程中出现白细胞低、发热,病情加重,家属要求自动出院后死亡;其余14例精神、发育等情况良好,均未出现脑积水复发及肿瘤复发与播散。结论松果体区生殖细胞瘤合并脑积水,脑室镜下病变活检+第三脑室底造瘘术,既可以明确诊断,还可以治疗脑积水;术后根据进行针对性放化疗,预后良好。
Objective To summarize the experience in diagnosis and treatment for the patients with pineal region germinoma(PRG)associated with obstructive hydrocephalus(OH).Methods The clinical data of 15 patients with PRG associated with OH who underwent endoscopic biopsy(EB)and endoscopic third ventriculostomy(EVT)from September 2016 to September 2019 were analyzed retrospectively.The patients without elevation of serum alpha fetoprotein(AFP)received radiotherapy(36 Gy)to the whole brain and whole spinal cord plus radiotherapy(42 Gy)to the tumor after the surgery.The patients with elevation of serum AFP received radiotherapy to the whole brain and spinal cord plus cisplatin/etoposide chemotherapy after the surgery.Results EBs were successfully completed and the diagnoses were confirmed in all the patients.EVT were successful completed in 14 patients and 1 failed who was changed to transparent sepstomy and Ommaya capsule implantation.The followed up ranged from 8 months to 45 months,with an average of 24 months.One patient died due to low white blood cell and fever during radiotherapy and chemotherapy.No recurrence of hydrocephalus and tumor recurrence and dissemination occurred in 14 survived patients who developed well.Conclusions For patients with PRG associated with OH,EB and EVT can not only confirm the diagnosis,but also treat the hydrocephalus.Good prognoses can be achieved in the patients with PRG associated with OH by corresponding radiotherapy and chemotherapy based on the patients'condition after EB and EVT.
作者
陈勇
张晓青
郑新
李松
杨辉
CHEN Yong;ZHANG Xiao-qing;ZHENG Xin;LI Song;YANG Hui(Department of Neurosurgery,Army Medical University,Xinqiao Hospital,PLA,Chongqing 400037,China)
出处
《中国临床神经外科杂志》
2021年第9期670-672,共3页
Chinese Journal of Clinical Neurosurgery
基金
陆军军医大学苗圃人才计划(2019R054)。
