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目的探讨丘脑胶质瘤的影像学特征与手术入路的选择。方法回顾性分析我科显微手术治疗的20例丘脑胶质瘤的影像学特征、手术入路及术后情况。结果术前MRI提示肿瘤主体位于丘脑外侧近岛叶2例,位于丘脑后外侧18例;内囊后肢位于肿瘤前外侧方16例,侧方4例。本组经外侧裂岛叶入路2例,经颞-侧脑室入路6例,经颞顶或顶枕-侧脑室三角区入路12例。肿瘤全切除14例,次全切除3例,大部分切除3例。术后症状改善11例,无明显变化5例,症状加重4例。随访2个月~1年,肿瘤复发2例。结论显微手术是治疗丘脑胶质瘤的有效手段,肿瘤位置、生长方式及瘤体与内囊后肢的关系有助于个体化制定手术入路和切除范围。
Objective To explore the imaging features and the choice of surgical approaches for thalamic gliomas. Methods We retrospectively analyzed the imaging features, surgical approach and postoperative status of 20 cases of thalamic glioma treated with microsurgery in our department. Results The preoperative MRI showed that the main tumor located in the lateral island of the hypothalamus in 2 cases near the posterolateral thalamus in 18 cases; the posterior limb of the internal capsule in the anteroposterior side of 16 cases, lateral 4 cases. In this group, there were 2 cases of lateral island fissure approach, 6 cases of temporal-lateral ventromedial approach, and 12 cases of pathologic approach through the temporal or apical occipital-lateral ventricles. Tumor resection in 14 cases, subtotal resection in 3 cases, the majority of resection in 3 cases. Postoperative symptoms improved in 11 cases, no significant change in 5 cases, 4 cases of aggravating symptoms. Follow-up 2 months to 1 year, 2 cases of tumor recurrence. Conclusions Microsurgery is an effective method for the treatment of thalamic glioma. The relationship between tumor location, growth pattern and tumor and hind limbs of internal capsule is helpful to develop the surgical approaches and resection scopes individually.