目的:研究比较松果体区肿瘤的显微外科手术切除不同手术入路及其优缺点。方法:回顾分析收治的48例松果体区肿瘤患者的手术情况及术后表现,并进行分析。结果:48例患者中,经枕小脑幕切开(Poppen)入路31例,幕下小脑上(Krause)入路8例,经胼胝体-穹窿间入路6例,经胼胝体后部(Dandy)入路2例,颞部侧脑室三角部入路1例。肿瘤全切除40例,次全切除5例,大部分切除3例。8例未全切者及病理证实为恶性的病变术后行放疗和(或)化疗,5例术后并发脑积水行分流术,偏盲1例,死亡2例,随访6个月~6年,KPS大于80分者约43例。结论:松果体区肿瘤的手术治疗效果较好,全切率高、死亡率低,合理的入路及体位,娴熟的显微外科手术技巧是手术成功的关键,Poppen入路和Krause入路是符合微创理念的理想入路。
摘要:目的:探讨伽玛刀治疗颅内肿瘤并发放射性脑损伤的MRI影像表现及其组织病理学基础。方法:回顾性分析8例经手术及病理证实的放射性脑损伤的MRI表现;其中,星形胶质细胞瘤4例,转移性腺癌2例,血管母细胞瘤1例,鼻咽癌1例。结果:病变位于小脑半球、额叶、颞叶及顶叶,8例9个病灶共有2种MRI表现:5例6个病灶平扫T1WI呈低、等信号,T2WI呈稍高、高信号,增强扫描呈“结节状”、“花环状”强化;3个病灶平扫为类圆形,T1WI呈均匀低信号,T2WI呈高信号,边界清楚,增强扫描囊腔无强化,囊壁轻度均匀强化。所有病例均有占位效应。结论:伽玛刀所致放射性脑损伤具有一定的特征性,特别是囊状坏死。
ObjectiveAnalysis prophylactic anti-epileptic drugs (AEDs) therapy in patients with brain tumor-related epilepsy (BTE) to observe whether seizures occurance, frequency will decrease, and the adverse reactions risk assessment of the patient's after using AEDs in 3 months and 12 month. MethodsRetrospective analysis of the cases and follow-up data of patients with the diagnosis of brain tumors in the Second Affiliated Hospital of Chongqing Medical University in June 2011 to February 2015. Through the strict inclusion criteria and exclusion criteria review, the sixty-eight standard patients were divided into two groups:treatment group (44 cases) and control group (24 cases), and compared in the incidence of epilepsy and seizure frequency two groups of patients, and observe the adverse reactions after using AEDs. And analyzed the outcome of patients with brain tumors at 3 months and 2 months. ResultsThrough at least 1 year follow up, compared the data of patients in the two groups with seizure incidence at 3 months and with seizures frequency≥3 times at 12 months, the difference was statistically significant (P < 0.05).In the treatment group, however, 7 patients experienced mild adverse reactions, such as dizziness, fatigue, nausea and vomiting, mild white blood cell reduction, mild liver damage, menstrual cycle changes, mental and behavioral abnormalities, etc.A patient discontinued due to mental disorder, and a patient change AEDs due to menstrual cycle change. All patients had no serious adverse reactions. Conclusions①prophylactic use of AEDs can significantly reduce the incidence of seizures at 3 months; ②Although prophylactic use of AEDs did not reduce the incidence of seizures at 12 months, but can reduce the frequency of seizures; ③The risk of adverse reactions of prophylactic use of AEDs in patients with BTE is relatively low.