• 四川大學(xué)華西醫(yī)院神經(jīng)外科,四川成都 610041;

目的:探討松果體區(qū)腫瘤的治療策略。方法:我院自2003年12月至2007年12月收治的58例松果體區(qū)腫瘤,按腫瘤標(biāo)志物甲胎蛋白(AFP)和人β促絨膜性腺激素(hCG-β)將其分為標(biāo)志物增高組和正常組,回顧分析兩組臨床資料和治療體會。結(jié)果:腫瘤標(biāo)志物正常組36例,其中27例行手術(shù)切除腫瘤,9例行伽馬刀治療(其中5例行伽馬刀加腦室腹腔分流治療)。術(shù)后4例因病理報告示生殖細(xì)胞瘤行伽馬刀補充治療,3例因梗阻性腦積水行腦室腹腔分流。增高組22例,均選用伽馬刀治療(其中17例合并梗阻性腦積水者行伽馬刀加腦室腹腔分流)。治療后3例因癥狀緩解不佳行手術(shù)切除腫瘤術(shù)。手術(shù)病例中24例采用經(jīng)胼胝體入路,4例經(jīng)枕部小腦幕入路,2例經(jīng)幕下小腦上入路。手術(shù)全切24例,次全切5例,部分切除1例,術(shù)后住院期內(nèi)死亡者1例。病理診斷:生殖細(xì)胞瘤14例,畸胎瘤5例,中樞神經(jīng)細(xì)胞瘤4例,室管膜瘤2例,表皮樣囊腫2例,腦膜瘤1例,膠質(zhì)瘤1例,皮樣囊腫1例。放射外科治療病例中28例術(shù)后3個月臨床癥狀明顯改善,4例隨訪期內(nèi)腫瘤無明顯變化,3例腫瘤增大。2例放療后出現(xiàn)鞍區(qū)轉(zhuǎn)移。結(jié)論:松果體區(qū)腫瘤組織類型多樣,應(yīng)盡可能先明確腫瘤性質(zhì)后選擇合理治療策略。

引用本文: 牟科杰,毛慶,劉艷輝. 松果體區(qū)腫瘤的治療策略研究. 華西醫(yī)學(xué), 2009, 24(1): 14-17. doi: 復(fù)制

1. Grossman RG,Lxjfius CM.王任直主譯.Principles of Neurosurgery[M].北京:人民衛(wèi)生出版社,2002:437-443..
2. Gerhard P.Management of pineal region tumors[J].Neurosurg Q,2002,12(4):279-298. [3]Araki C,Matsumoto S.Statistical reevaluation of pinealoma and related tumors in Japan[J].J Neurosurg,1969,30:146-149..
3. Sano K.Diagnosis and treatment of tumors in the pineal region[J].Acta Neurochir (Wien),1976,34:153-157..
4. 王立根,郭艷,章翔,等.立體定向放射神經(jīng)外科治療松果體區(qū)腫瘤[J].立體定向和功能性神經(jīng)外科雜志,2001,14(2):86-88..
5. Friedman WA,F(xiàn)oote KD.Linear accelerator radiosurgery in the management of brain tumors[J].Ann Med,2000,32:64..
6. 漆松濤,張喜安,潘軍.顯微手術(shù)切除松果體區(qū)腫瘤(附34例報告)[J].中國神經(jīng)精神疾病雜志,2003,29(4):265-268..
7. Oi S.Recent advences and racial diferences in therspeutic strategy to the pineal region tumor[J].Childs Nerv Syst,1998,14(12):33-35..
8. 梁樹立.松果體區(qū)腫瘤的外科治療[J].國外醫(yī)學(xué)神經(jīng)病學(xué)神經(jīng)外科學(xué)分冊,2001,28(3):149.
9. 〖ZK(#〗Fauchon F,Jouvet A,Paquis P,et al.Parenchymal pineal tumors:a clinicopathological study of 76 cases[J].Int J Radiat Oncol Biol Phys,2000,46(4):959-968..
10. Kang JK,Jeun SS,Hong YK.Experience with pineal region tumors[J].Childs Nerv Syst,1998,14(12):63-68..
11. Bruce JN,Ogden AT.Surgical strategies for treating patients with pineal region tumor[J].J Neurooncol,2004,69(13):221-236..
12. Konovalov AN,Pitskhelaur DI.Principals of treatment of the pineal region tumors[J].Surg Neurol,2003,59(4):250-268..
13. Pople IK,Athanasiou TC,Sandeman DR,et al.The role of endoscopic biopsy and third ventriculostomy in the management of pineal region tumors[J].Br J Neurosurg,2001,15(4):305-311..
14. Oi S,Kamio M,Joki T,et al.Neuroendoscopic anatomy and surgery in pineal region tumors:role of neuroendoscopic procedure in the ‘minimallyinvasive preferential’ management[J].J NeuroOncol,2001,54(3):277-286..
15. Chernov MF,Kamikawa S,Yamane F,et al.Neurofiberscopic biopsy of tumors of the pineal region and posterior third ventricle:indications,technique,complications,and results[J].Neurosurgery,2006,59(2):267-277..
16. Pople IK,Athanasiou TC,Sandeman DR,et al.The role of endoscopic biopsy and third ventriculostomy in the management of pineal region tumors[J].Br J Neurosurg,2001,15(4):305-311.
  1. 1. Grossman RG,Lxjfius CM.王任直主譯.Principles of Neurosurgery[M].北京:人民衛(wèi)生出版社,2002:437-443..
  2. 2. Gerhard P.Management of pineal region tumors[J].Neurosurg Q,2002,12(4):279-298. [3]Araki C,Matsumoto S.Statistical reevaluation of pinealoma and related tumors in Japan[J].J Neurosurg,1969,30:146-149..
  3. 3. Sano K.Diagnosis and treatment of tumors in the pineal region[J].Acta Neurochir (Wien),1976,34:153-157..
  4. 4. 王立根,郭艷,章翔,等.立體定向放射神經(jīng)外科治療松果體區(qū)腫瘤[J].立體定向和功能性神經(jīng)外科雜志,2001,14(2):86-88..
  5. 5. Friedman WA,F(xiàn)oote KD.Linear accelerator radiosurgery in the management of brain tumors[J].Ann Med,2000,32:64..
  6. 6. 漆松濤,張喜安,潘軍.顯微手術(shù)切除松果體區(qū)腫瘤(附34例報告)[J].中國神經(jīng)精神疾病雜志,2003,29(4):265-268..
  7. 7. Oi S.Recent advences and racial diferences in therspeutic strategy to the pineal region tumor[J].Childs Nerv Syst,1998,14(12):33-35..
  8. 8. 梁樹立.松果體區(qū)腫瘤的外科治療[J].國外醫(yī)學(xué)神經(jīng)病學(xué)神經(jīng)外科學(xué)分冊,2001,28(3):149.
  9. 9. 〖ZK(#〗Fauchon F,Jouvet A,Paquis P,et al.Parenchymal pineal tumors:a clinicopathological study of 76 cases[J].Int J Radiat Oncol Biol Phys,2000,46(4):959-968..
  10. 10. Kang JK,Jeun SS,Hong YK.Experience with pineal region tumors[J].Childs Nerv Syst,1998,14(12):63-68..
  11. 11. Bruce JN,Ogden AT.Surgical strategies for treating patients with pineal region tumor[J].J Neurooncol,2004,69(13):221-236..
  12. 12. Konovalov AN,Pitskhelaur DI.Principals of treatment of the pineal region tumors[J].Surg Neurol,2003,59(4):250-268..
  13. 13. Pople IK,Athanasiou TC,Sandeman DR,et al.The role of endoscopic biopsy and third ventriculostomy in the management of pineal region tumors[J].Br J Neurosurg,2001,15(4):305-311..
  14. 14. Oi S,Kamio M,Joki T,et al.Neuroendoscopic anatomy and surgery in pineal region tumors:role of neuroendoscopic procedure in the ‘minimallyinvasive preferential’ management[J].J NeuroOncol,2001,54(3):277-286..
  15. 15. Chernov MF,Kamikawa S,Yamane F,et al.Neurofiberscopic biopsy of tumors of the pineal region and posterior third ventricle:indications,technique,complications,and results[J].Neurosurgery,2006,59(2):267-277..
  16. 16. Pople IK,Athanasiou TC,Sandeman DR,et al.The role of endoscopic biopsy and third ventriculostomy in the management of pineal region tumors[J].Br J Neurosurg,2001,15(4):305-311.