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中国神经肿瘤杂志

中国神经肿瘤杂志

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中国神经肿瘤杂志 >2013年第4期

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  • 摘要：近年内镜技术的快速发展.为中枢神经系统肿瘤的治疗提供了新的手术选择.最初一些脑内或脑室内的小型囊性肿瘤,可在内镜下活检或切除.随着器械的完善和技术的改进,许多脑内、脑室内、蛛网膜下腔和颅底中线区的实性肿瘤,都可采用不同方法,在内镜下安全切除.
  • 摘要：背景与目的:近年来随着内镜光学技术的发展和五官科医生在鼻窦手术中广泛使用内镜,内镜在经蝶窦垂体腺瘤外科中的应用逐渐被熟知.本研究主要探讨神经内镜下再次经蝶窦手术治疗复发垂体腺瘤的安全性及临床疗效.方法:对12例经蝶手术后复发的垂体瘤患者进行了内镜下再次经蝶切除术,观察其安全性、肿瘤切除情况及手术并发症等.结果:内镜下全切除8例,次全切除2例,大部分切除2例.本组术后无死亡及严重并发症,常见并发症为一过性尿崩症、电解质紊乱和脑脊液鼻漏,术后83%(10/12)患者临床症状明显改善,12例随访6个月至5年,疗效满意.结论:神经内镜下再次经蝶窦手术治疗复发性垂体腺瘤是安全有效的,而熟练的内镜技术和可靠的颅底重建是手术成功的关键.
  • 摘要：背景与目的:1992年Jankowski等首次在内镜下行经鼻蝶入路垂体瘤切除以来,经过十几年的探索和努力,内镜经鼻蝶、扩大经鼻蝶入路肿瘤切除术日趋成熟,广泛应用于垂体瘤、脊索瘤等颅底肿瘤的切除.该术式安全、微创、有效.并发症的发生率远低于传统术式,但出血性血管损伤是该术式最严重的并发症之一,如处理不当可明显影响患者预后,本文将着重探讨该入路肿瘤切除术术中、术后出血原因及对策.方法:对111例单鼻孔内镜下经蝶、扩大经蝶入路肿瘤切除术病例进行回顾性分析,其中垂体瘤91例.脊索瘤9例,Rathe囊肿5例,颅咽管瘤3例,骨纤维结构不良1例,血管网状细胞瘤1例,骨软骨瘤1例. 结果:肿瘤全切92例(82.9%),次全切16例(14.4%),部分切除3例(2.7%);术中出血心<200ml 92例(82.9%),>200ml 17例(15.3%),>1000ml 2例(1.8%);术后鼻衄2例(1.8%);术后鞍上血肿4例(3.6%).结论:单鼻孔内镜下经蝶入路、扩大经蝶入路肿瘤切除术术中、术后出血为该入路严重的并发症,应通过正确操作、及时处理避免其发生.
  • 摘要：背景与目的:化疗是胶质瘤重要的辅助治疗方法.本研究联合替尼泊苷(VM-26)与尼莫司汀(AC-NU)治疗O6-甲基鸟嘌呤-DNA甲基转移酶(O6-methylguanine-DNA methyltransferase,MGMT)阴性表达的恶性胶质瘤患者,观察其疗效,评价其不良反应.方法:2006年12月至2008年12月,18例患者经手术或立体定向活检确诊为恶性胶质瘤(WHO分级为Ⅲ或Ⅳ级),患者既往均接受过放疗,其中大多数(13例)接受过化疗后复发者.肿瘤组织免疫组织化学检测提示MGMT蛋白呈阴性表达,接受VM-26与ACNU联合方案化疗.化疗方案为VM-26,80～100mg/(m2·d),d1-3;ACNU,2-3 mg/kg,d1,6～8周重复一次.按WHO实体瘤疗效评价标准评价疗效.按美国国立癌症研究所(National Cancer Institute.NCI)评价标准评价不良反应.结果:18例患者共行70周期化疗,平均3.9个周期(2～6个周期).化疗的主要剂量限制性毒性为骨髓抑制,Ⅲ、Ⅳ级中性粒细胞减少症发生率分别为51.4%(36/70)、25.7%(18/70),Ⅲ、Ⅳ级血小板减少症发生率分别为24.3%(17/70)、12.9%(9/70).按既往是否接受化疗,患者可分为既往接受化疗组、未接受化疗组,两组间Ⅲ、Ⅳ级中性粒细胞减少症及Ⅲ、Ⅳ级血小板减少症发生率元显著性差异(均P>0.05).18例患者中.无完全缓解(complete response,CR)病例,1例(5.6%)部分缓解(partial response,PR).13例(72.2%)微效(minor response,MR),3例(16.7%)稳定(stabledisease,SD),1例(5.6%)进展(progressive disease,PD).客观有效率(CR+PR)为5.6%,总反应率(CR+PR+MR)为88.9%,疾病控制率(CR+PR+MR+SD)为94.4%.从使用本方案化疗开始计算,患者中位无进展生存期(PFS)为2.6个月(95%CI:2.49-2.90),6个月PFS%为36%;中位总生存(OS)为6.7个月(95%CI:3.35-11.1).结论:VM-26与ACNU联合方案主要不良反应为Ⅲ、Ⅳ级骨髓抑制,但可控制.VM-26与ACNU联合方案治疗恶性脑胶质瘤,可取得较高的总反应率和疾病控制率.
  • 摘要：背景与目的:松果体区肿瘤的位置深在,毗邻重要的结构,病理类型丰富,故其诊断及治疗一直是神经外科最富挑战和争议的领域.本研究总结应用神经内镜治疗合并梗阻性脑积水的松果体区肿瘤的疗效,评价神经内镜在诊治过程中的作用.方法:对53例合并梗阻性脑积水的松果体区肿瘤患者应用神经内镜行第三脑室底造瘘加肿瘤活检术,在解决脑积水同时明确肿瘤病理性质.其后给予综合治疗.结果:本组病例术后梗阻性脑积水均解除,51例获病理结果.结论:在合并梗阻性脑积水的松果体区肿瘤的初期治疗中,神经内镜是一种有效的诊疗手段.
  • 摘要：1 病例报告rn患者男性,24岁.颅咽管瘤经鼻蝶手术后40天,头痛、呕吐4天,加重伴发热1天.术后无脑脊液漏病史,出院时一般情况好,体温正常.出院期间有上呼吸道感染史.入院当日体温39～40~C,腰穿化验脑脊液:白细胞680/μl.
  • 摘要：背景与目的:颅咽管瘤位置深在,毗邻重要的结构,手术全切肿瘤往往比较困难.本研究探讨经纵裂经终板入路切除颅咽管瘤的手术技巧.方法:回顾性分析了经纵裂经终板入路切除的14例颅咽管瘤的手术经过与疗效,重点讨论了手术入路技术、肿瘤切除技术和垂体柄的保护技术.结果:肿瘤全切除13例(92.8%),次全切除1例,无手术死亡,术后视力症状(6例)均较术前好转,术后出现的尿量增多与低钠血症持续3～35天,给予垂体后叶索和常效尿崩停(弥凝)均可控制.结论:经纵裂经终板入路是切除颅咽管瘤的有效手术途径.
  • 摘要：无
  • 摘要：背景与目的:肺癌脑转移的临床预后较差,本研究观察尼莫司汀配合放疗治疗肺癌多发性脑转移的疗效及不良反应.方法:35例肺癌多发脑转移患者,放疗后使用尼莫司汀单药化疗.全脑放疗为DT1.8～2Gy/次,5次/周,总剂量36～40Gy.尼莫司汀化疗平均剂量125mg/次,每4～6周重复,所有患者使用2～3次.治疗期间注意血常规及肝肾功能变化情况,并给予脱水、支持对症治疗.在放疗结束后3个月复查脑MRI,观察肿瘤大小,并统计1年生存情况.结果:所有病例在治疗期间无颅内、外病灶进展病例,28例伴有神经症状者均得到缓解.放疗结束后3个月单纯颅内病灶评价:其中CR 5例,PR 26例,SD 4例,PD 0例.颅内病灶有效率(CR+PR)为88.6%(31/35).一年生存率为45.7%(16/35),中位生存期9.3个月.不良反应主要是脑充血水肿以及尼莫司汀化疗反应,多为Ⅰ、Ⅱ度.无Ⅳ度不良反应.结论:尼莫司汀配合放疗治疗肺癌多发性脑转移的疗效好,不良反应轻,远期效果尚需进一步观察.
  • 摘要：无
  • 摘要：无
  • 摘要：背景与目的:随着微侵袭神经外科的发展,神经内镜在神经外科的应用范围日趋广泛.本研究的目的是探讨神经内镜下经鼻蝶入路手术治疗垂体腺瘤的疗效.方法:对300例垂体腺瘤患者采用神经内镜下经鼻蝶入路垂体腺瘤切除术.其中微腺瘤60例,大腺瘤228例,巨型腺瘤12例.观察疗效及并发症.结果:肿瘤全切255例,近全切32例,大部分切除13例;无死亡病例:无严重并发症发生.术后随访3～12个月,原有症状均有明显改善,术前异常增高的激素水平均降至正常.MRI检查显示无肿瘤复发.结论:在神经内镜下经单鼻孔蝶窦入路垂体腺瘤切除术具有深部照明好,鼻腔结构损伤小,切除肿瘤彻底,术后并发症少,恢复快等优点.
  • 摘要：随着影像学技术的发展,透明隔囊肿的诊断率也提高了.症状性透明隔囊肿(symptomatic septumpellucidum cyst,SSPC)需要手术治疗.现在大多数神经外科治疗中心已经常规选择神经内镜下囊肿壁开窗术治疗SSPC.这应该是治疗SsPC的首选方法.但是,直到现在仍然没有统一的SSPC诊断和治疗标准.
  • 摘要：BACKGROUND & OBJECTIVE:Expression of O6methylguanine-DNA methyltransferase (MGMT) has been related to drug resistance of glioma patients. This article is to analyze whether personalized chemotherapy based on MGMT expression could be benefit to patients with MGMT positive gliomas. METHODS:There were 57 malignant glioma padents(anaplastic oligodendroglioma, AO 3 cases,anaplastic astrocytoma, AA 36 cases,glioblastoma multiforme, GBM 18 cases)received chemotherapy in Cancer Center ofSun Yat-sen University, based on MGMT expression, and response as well as survival time were evaluated. Thirty-five patients with MGMT positive tumors received chemotherapy regimens, which consisted of no-alklating agent regimen or cisplatin plus TMZ regimen, or combination of TMZ or nitrosoureas with no-alldafing agent (teniposide (VM-26), cisplatin (DDP), carboplatin (CBP), isophosphanfide (IFO), etoposide (VP16)). While 22 patients with MGMT negative tumors,there was no restriction on chemotherapy regimen. That was eigther nitrourea or TMZ had been used in the regimen,and the most commonly used regimen were PCV;TMZ+VM26; MeCCNU +VM26. RESULT: Although objective response (OR) and response rate (RR) in the patients with MGMT negative tumors were higher than that in the patients with MGMT positive tumors, but there was no statistical significance between those two groups (P >0.05). By following up 0.7-53.4 months (mean 11.7 months), progressive-free survival (PFS) in MGMT negative and positive patients were 8.5 months(95% CI 4.8-19.3) and 6.7 months(g5% CI 3.7-9.3), and overall survival(OS) were 20.3 months (95% CI 14.3-) and 16.1 months (95% CI 11.1-26.2, respectively. (P>0.05). CONCLUSIONS:Our results indicated that personized chemotherapy for glioma patients based on MGMT expression can obtain satisfactory results especially for patients with MGMT positive gliomas.%背景与目的:O6-甲基鸟嘌呤-DNA甲基转酶(O6-methylguanine-DNA methyhransferase,MGMT)表达与胶质瘤患者的化疗耐药相关.本研究总结MGMT高表达和低表达恶性胶质瘤患者的化疗方案、近期疗效和生存情况,分析选择性化疗是否对MGMT高表达患者有益.方法:自2000年8月至2006年1月,中山大学肿瘤防治中心神经肿瘤科收治的经手术后病理确诊的成人恶性脑胶质瘤患者57例,所有病例化疗前均有可评价病灶.化疗前用免疫组化方法检测肿瘤组织MGMT表达情况,对MGMT高表达者,尽量避免使用亚硝脲类或替莫唑胺单药化疗,采用不舍亚硝脲类或替莫唑胺方案,或由替莫唑胺(temozolomide,TMZ)和顺铂组成联合化疗方案;或亚硝脲类药物、替莫唑胺分别与其他细胞毒药物组成联合化疗方案(VM-26、DDP、CBP、IFO、VP16);对MGMT低表达者,不限制亚硝脲类药物或替莫唑胺的应用.结果:35例患者MGMT高表达,22例MGMT低表达,MGMT低表达组的客观有效率(objective response,OR)和疾病控制率(response rate,RR)高于MGMT高表达组(40.9%:22.9%和72.7%:60.0%),但差异无统计学意义(P>0.05).57例中位随访时间11.7个月(0.7～53.4).MGMT低表达组和高表达组中位无疾病进展时间(progressive-free survivat,PFS)分别是85个月(95%CI 4.8～193)和6.7(95%CI 3.7～9.3),中位生存时间(overall survival,OS)分别是20.3(95%CI 14.3～)和16.1(95%CI 11.1～26.2),中位PFS和OS在MGMT低表达组和高表达组差异无统计学意义(P>0.05).结论:在化疗前检测恶性胶质瘤MGMT表达情况,对MGMT高表达患者选用有助于克服耐药的化疗方案进行选择性化疗,可使MGMT高表达患者的近期疗效(客观有效率和疾病控制率)和生存时间(无疾病进展生存和总生存)达到MGMT低表达患者水平.
  • 摘要：脑干胶质瘤的预后相当不理想,放疗和化疗是两种非常重要的辅助治疗手段,而无论是放疗还是化疗都要求有明确的病理诊断.但是,对于弥漫生长而无法切除的脑干胶质瘤活检的必要性至今仍颇受争议,很多学者认为脑干部位弥漫生长的肿瘤活检面临很大风险却缺乏直接治疗作用,而且认为即使没有病理诊断也能够获得比较可靠的临床诊断.因此,对于有脑干胶质瘤典型临床和影像学表现的患者,我们是否还有必要活检呢?本文报告一例临床诊断为桥脑胶质瘤的女性患者,患者没有接受活检,仅经过放疗和化疗,取得了非常理想的效果.%The prognosis of brain stem glloma patient is extremely poor. Radiotherapy and chemotherapy are two mainstay therapies. Histological diagnosis is usually required before the treatments. However, The necessity to biopsy of brain stem diffuse glioma remains controversial. Many authors consider that biopsy provides little clinical benefit but great risk,and believe that a reliable diagnosis can be made without pathological confirmation. Therefore, question rise that does biopsy necessary for patient with typical clinical history and MRI imagings of brainstem glioma? In this article, we report a case of female patient with clinical diagnosis of pontine glloma, who was treated with radiotherapy followed by chemotherapy without biopsy, and achieved a definite clinical response.
  • 摘要：背景与目的:松果体区肿瘤治疗目前仍存在争议,为此我们进一步探讨松果体区肿瘤的临床特点及显微手术治疗.方法:回顾性分析2002～2008年收治的21例松果体区肿瘤患者的临床资料.结果:肿瘤全切除15例,次全切除4例,部分切除2例.21例的手术病理结果中,生殖细胞瘤9例、松果体母细胞瘤5例、胶质瘤2例及其他肿瘤5例.结论:松果体区肿瘤的诊断须以病理组织学分类为依据,松果体区静脉系统是阻碍手术操作的主要结构,显微外科手术应可良好地保护此区静脉,是松果体区肿瘤全切除的关键所在.%BACKGROUND & OBJECTIVE: The management of tumors in pineal region remain a challenge for neurosurgeons. In this article, we discussed the clinical characteristics and mierosurgery of these tumors.METHODS: The clinical date of 21 patients with tumors in pineal region treated in our hospital from 2002 to 2008 were analyzed retrospectively. RESULT: Among 21 patients, total removal was achieved in 15 cases,subtotal removal in 5 cases and partial removal in 2 cases, respectively. As for pathology, 9 cases were diagnosed as germ cell tumor, 5 cases as pinealoblastoma, 2 casess as glioma, and 5 cases as others tumor types,respectively.CONCLUSIONS: Diagnosis of tumors in pineal region should be confirmed by pathology. It,s important to protect the venous system around the pineal region during the tumor resection.
  • 摘要：BACKGROUND&OBJECTIVE: Photodynamic therapy is one of the treatment strategies for gliomas. In this study, we investigated the effect of photodynamic therapy on implanted C6 glioma cells in rat brain combined with glutamate receptor antagonist MK801 and CNQX. METHODS: C6 glioma cells were implanted in 32 rat brains. Rats were divided into four groups (8 animals per group): the control group, PDT group, FDT + MK801 group and PDT + CNQX group. After PDT, the average survival time, the tumor volume and pathological characteristics were observed. RESULT: The average survival time of the four groups was (28.9±2.4) d for control group,(40.3±2.3) d for PDT group,(34.9±2.6) d for PDT + CNQX group and (44.5±2.5) d for PDT + MK801 group, respectively. The tumor volume determined by MRI after 10 days of PDT was (29.54±6.43) mm3 for control group, (21.49±0.41) mm3 for PDT group, (24.60±0.53) mm3 for PDT + CNQX group and (18.50±0.47) mm3 for PDT + MK801 group. CONCLUSIONS: PDT prolongs the average survival time of tumor-bearing rats. MK801 enhances the effect of PDT while CNQX decreases the effect.KEY WORD: CNQX ; MK801;Photodynamic therapy(PDT); Glioma%背景与目的:胶质瘤是神经外科领域研究的难点.本研究观察NMDA型谷氨酸受体拮抗剂 MK801和AMPA型谷氨酸受体拮抗剂CNQX对光动力治疗(photodynamic therapy,POT)大鼠颅内C6胶质瘤的影响.方法:32只颅内种植C6胶质瘤的荷瘤鼠随机分为单纯光照射组(n=8)、PDT治疗组(n=8)、PDT+MK801组(n=8)和PDT+CNQX组(n=8),行PDT治疗,并使用微透析仪局部给予MK801和CNQX,观察了动物生存期、肿瘤体积、尸检病理情况.结果:PDT+MK801组荷瘤鼠平均生存期最长[(44.5±2.5)d],PDT组次之[(40.3±2.3)d],PDT+CNQX组为(34.9±2.6)d.单纯光照射组最短[(28.9±2.4)d],荷瘤鼠PDT治疗或光照射后10d肿瘤体积单纯光照射组最大,为(29.54±6.43)mm3,PDT+CNQX组次之,为(24.60±0.53)mm3;PDT组荷瘤鼠C6胶质瘤体积为(21.49±0.41)mm3;PDT+MK801组肿瘤体积最小,为(18.50±0.47)mm3.结论:PDT治疗能延长荷瘤动物的生存期;MK801可以增强光动力治疗胶质瘤的效果,而CNQX却降低了光动力治疗胶质瘤的效果.
  • 摘要：背景与目的:蛋白激酶C(protein kinase C,PKC)参与肿瘤的发生、发展及预后.本研究探讨蛋白激酶Ca(Protein kinase Cα,PKCα)在人神经胶质瘤耐药细胞株SHG-44/ADM发生细胞凋亡中的作用和机制.方法:应用阿霉索浓度递增和间歇诱导法建立SHG-44/ADM耐药株,采用PKCα激活剂PMA和抑制剂Staurosporine 分别干预SHG-44/WT和SHG-44/ADM细胞株,激酶分析PKCα活性,荧光分光光度计检测细胞内阿霉素浓度,流式细胞仪检测细胞凋亡率.结果:PKCα激活剂PMA增强细胞PKCα和MDR-1的活性,同时降低细胞凋亡率;PKCα抑制剂Staumsporine抑制细胞PKCα和MDR-1的活性,增加细胞凋亡率.结论:PKCα通过MDR-1参与神经胶质瘤耐药细胞的凋亡.%BACKGROUND & OBJECTIVES: Protein kinase C is associated with the initiation,progression and treatment-resistance of tumors. In this study, we investigated the molecular mechanism and effect of protein kinase Cot in apoptosls of drug-resistant human glloma SHG-44/ADM cell line. METHODS: Drug-resistant glioma cell line SHG-44/ADM was established by intermittently treating SHG-44 cells with increasing edriamycin.SHC-44/WT and SHG-44/ADM were treated with adriamycin combined with either PKCα activator PMA or PKCα inhibitor Staurosporine. PKCα activity was determined by kinase assay. Adriamycin accumulation was determined by fluorescence spectrometry, and apoptosis was measured with flow cytometry. RESULT: PMA increased PKCα and MDR-1 activity, and inhibited apoptosis induced by adfiamycin. Whereas, staurosporine inhibited PKCα and MDR-1 activity, and enhanced apoptosis induced by adriamycin. CONCLUSIONS: The resistance of human glioma to adriamycin is mediated by PKCα via MDR-1.
  • 摘要：背景与目的:听神经瘤是中枢神经系统常见的良性肿瘤之一,其治疗有几种不同的手术入路,但枕下乙状窦后入路应用最为广泛.本研究探讨经枕下乙状窦后入路治疗听神经瘤的显微外科技术及疗效.方法:回顾性分析30例听神经瘤患者临床资料,均经枕下乙状窦后入路行显微手术切除,术中显露横窦和乙状窦,放出枕大池脑脊液,再行显微镜下分离及切除肿瘤,分析显微手术过程及治疗效果.结果:术后无1例患者死亡,肿瘤总体全切率90.0%(27/30),次全切除3例,面神经解剖保留率为93.33%,面神经功能保留率为66.7%.结论:掌握桥小脑角区的解剖学特征、显微手术技巧以及电生理监测在听神经瘤切除和颅神经功能保护中具有重要意义.%BACKGROUND&OBJECTIVE: Acoustic neuroma is one of the most common benign tumors in central nervous system, and the main treatment is surgical resection via subocciipital retrosigmoid approach. In this study, we explored techniques and efficacy of suboccipital retrosigmoidal approach in the treatment of acoustic neuromas. METHODS: Records of 30 patients with acoustic neuromas treated via suboccipital retmsigmoidal approach were analyzed, retrospectively. RESULTS: No modality was observed. Among 30 patients, total resection was achieved in 27 cases and subtotal resection in 3 cases. Facial nerve was preserved in 28 cases anatomically and in 20 cases functionally, respectively. CONCLUSION: The anatomy of cerebellopontine, microsurgical skills and electrophysiological monitoring play important role in the removal of acoustic neuromas and cranial nerves protection.
  • 摘要：BACKGROUND & OBJECTIVE: Intracranial hemangioperieytoma is of rare incidence and is difficult to diagnose and treat. In this article, we reported 6 cases of intracranial hemangiopeficytomas and reviewed the literatures. METHODS: Clinical data of 6 intraeranial hemangiopericytomas including the manifestations, imaging, pathology, treatment and prognosis were investigated. The relevant literatures were reviewed. RESULT: All 6 patients underwent craniotomy. Total removal was achieved in 4 cases and subtotal removal in 2 cases. Among 6 cases, 5 patients received radiotherapy. The patients were followed up for 1 to 10 months. Recurence or metastasis was found in none of the 6 cases. CONCLUSIONS: Intracranial hemangiopericytoma is characteristic of activeproliferation and abundant blood supply. It is very important to make accurate diagnosis and make full preoperative preparation. Totally resection is the best treatment for this tumor. Radiotherapy is the main adjuvant treatment.%背景与目的:颅内血管外膜细胞瘤(hemangiopericytoma,HPC)发病率低,临床诊治困难,本研究旨在提高对颅内HPC的认识.方法:回顾总结6例颅内HPC患者的临床表现、影像、病理特点以及手术切除和预后情况,并且复习相关文献.结果:6例患者均行开颅手术治疗,其中全切除4例,近全切除2例;术后5例行放射治疗,1例拒绝放疗.术后随访1～10个月,尚未发现肿瘤复发及转移.结论:颅内HPC生长活跃,血供丰富,尤其是位于大脑镰及矢状窦旁时,因此要明确诊断,做好充分的术前准备;手术切除是最佳的治疗手段,应尽量全切,切除范围要广泛,放射治疗是主要的辅助治疗手段.
  • 摘要：自噬是胞浆长寿命蛋白质和细胞器在膜包囊泡中大量降解的生物学过程.自噬与人类的多种疾病,尤其是恶性肿瘤存在密切关系.外科手术是神经胶质瘤的主要治疗手段,其他的辅助治疗手段如放射治疗、化学治疗对提高胶质瘤的治疗效果具有重要意义.此外,生物免疫治疗、基因治疗和热疗等新的治疗手段对胶质瘤也具有一定的效果.本文对自噬在胶质瘤治疗中的作用进行了概述.%Autophagy is a biological process involving the degradation of long-lived proteins and organelles of cells. Autophagy is associated with many diseases including cancers. Surgery is the main treatment for glinma,while irradiation and chemotherapy also play important roles in glioma treatment. Besides, novel treatments such as bioimmunotherapy, gene therapy and hyperthermia also are effective for glioma. The role of autophagy in glioma treatment has been reviewed in this article.
  • 摘要：本文讨论了胶质母细胞瘤的病理组织学、分子遗传学和患者预后问的关系.病理组织学特征包括主要的细胞类型(小细胞,非小细胞)其他一些改变,如少突胶质细胞成分、星形细胞瘤区、肥胖细胞、多核巨细胞以及坏死和微血管增殖.大约20%的胶质母细胞瘤中可以见到少突胶质细胞成分,这些患者生存期稍长;LOH1p的胶质母细胞瘤病例生存期较长,而LOH19q的病例生存期较短.胶质母细胞瘤中大约有5%或更多的多核巨细胞,较之多核巨细胞少见的胶质母细胞瘤,常见有P53突变和少见的EGFR扩增.所有的胶质母细胞瘤中均可见微血管增殖.伴有大片血管性坏死区的患者生存期较短.这些特征提示胶质母细胞瘤的一些组织学改变和特殊的遗传学改变与临床预后相关.%In this article, the correlation among pathologic histology, molecular genetics and patient outcomes in glioblastomas was discussed. Pathologic histologic characteristics include major cell typos (small cell, Non small cell), and other components, such as oligodendroglial components, areas of astrocytoma, gemistocytes, multinucleated giant cells as well as necrosis and microvascular proliferation. An oligedendroglial component was detected in 20% of glioblastomas and patients with oligedendroglial components had better prognosis. LOH 1p was associated with longer survival whereas LOH19q was associated with shorter survival of patients with glioblasfoma.Glioblastomas containing more than 5% muhinucleated giant cells showed more frequent P53 mutation and infrequent EGFR amplilication than those containing leas than 5% multinueleated giant cells. Vascular proliferation was observed in all gLioblastomas. The patients with large areas of angionecrosis were associated with shorter survival.These characteristics in glioblastomas are associated with specific genetic alterations and with clinical outcome.
  • 摘要：无
  • 摘要：The balance between histone acetyltransferases (HATs) and histone deacetylases (HDACs)regulates normal cell differentiation and metabolism activity. Disturbance of the balance between HATs and HDACs can lead to cancers including glinmas. Glioblastoma (GBM) is a malignant tumor in central nervous system and the prognosls of patients with GBM is poor. The mechanism of gliomagenesis is still unknown., Histone deacetylase inhibitors (HDACI) was proven to inhibit gliomas cell growth and proliferation via various mechnisms,including cell cycle arrest, induction of cell differentiation and apoptosis, as well as inhibition of angiogenesis. In this article, we introduced HDACIs from the point of chemical structure and the mechanism of anti-glioma. ,We also reviewed the literatures of and valproic acid and its derivatives.%正常细胞的分化以及代谢行为的调节依赖组蛋白乙酰基转移酶和组蛋白去乙酰化酶之间的平衡.一旦这种平衡关系被打破,细胞或组织就容易发生癌变,神经胶质瘤也不例外.神经胶质瘤是一种恶性度高且预后极差的颅内肿瘤,其作用机制尚不明确且呈浸润性生长.因此在治疗手段方面尚无行之有效的方法.组蛋白去乙酰化酶抑制剂作为一种新型的化疗药物为胶质瘤的治疗提供了新的方向.它通过阻碍细胞周期、诱导细胞分化和凋亡以及抑制肿瘤血管生成来抑制神经胶质瘤的生长和增殖.本文旨在从化学结构特点和对神经胶质瘤作用机制两方面阐述组蛋白去乙酰化酶抑制剂,并对新的一类组蛋白去乙酰化酶抑制剂丙戊酸及其衍生物的研究作一综述.
  • 摘要：背景与目的:内侧型蝶骨嵴脑膜瘤手术全切难度大,并发症较多,是颅底外科的难题之.本研究探讨内侧型蝶骨嵴脑膜瘤显微外科手术中血管和神经的保护,进一步减少并发症,以提高肿瘤切除率.方法:采用经翼点入路对35例内侧型蝶骨嵴脑膜瘤进行显微神经外科手术切除,观察疗效和并发症,对与手术相关的血管和神经保护方法进行总结.结果:本组Simpson Ⅰ级切除22例(62.9%),Simpson Ⅱ级切除9例(25.7%),Simpson Ⅲ级切除4例(11.4%),无手术死亡.术前视力明显减退或视野缺损的22例中,术后明显好转16例,术后轻瘫2例、动眼神经麻痹1例,经积极治疗出院时恢复良好.结论:准确全面的术前评估,术中对视神经、海绵窦及其内神经、颈内动脉及其分支的保护,是提高内侧型蝶骨嵴脑膜瘤全切率、术后神经功能改善恢复和减少手术并发症发生的关键技术.%BACKGROUND&OBJECTIVE: It is a challenge to resect the medial sphenoid ridge meningiomas completely without damage to adjacent tissues. Here, we explored the microsurgical technique to protect the blood vessels and nerves in microneurosurgery of medial sphenoid ridge meningiomas. METHODS: The clinical data of 35 cases with medial sphenoid ridge meningiomas were analyzed restmspectively. The cases were treated via pterional approach. The main points of microsurgical technique to protect the blood vessels and nerves were discussed. RESULT:Simpson grade Ⅰ resection was achieved in 22 cases (62.9%), Simpson grade Ⅱ in 9 cases (25.7%) and Simpson grade Ⅲresection in 4 cases (11.4%), respectively. No mortality was observed. Among 22 cases with preoperative severe visual deterioration or visual field defect, 16 cases were markedly improved. Hemiplegia occurred in 2 cases and ocalomoter nerve palsy was observed in 1 case. CONCLUSION: It is important to manage and protect the vessels,nerves and the cavernous sinus region carefully through microsurgical techniques. The accurate preoperative evaluation and the skillful microsurgical technique are the keys to heighten total resection rate of the tumors, improve the restoration of the nerve function, and reduce the occurrence of complications postoperatively.
  • 摘要：PURPOSE： Resistance to temozolomide chemotherapy is partly mediated by O6-methylguanine-DNA methlytransferase （MGMT）. Protracted treatment with temozolomide potentially overcomes MGMT resistance and improves outcome. We conducted a phase II study of protracted daily temozolomide in adults with low-grade gliomas. EXPERIMENTAL DESIGN： Patients with newly diagnosed oligodendroglioma or oligoastrocytoma with a MIB-1 index of 〉5% or recurrent low-grade gliomas received temozolomide （75 mg/m2/ day in 11-week cycles of 7 weeks on/4 weeks off）. Treatment continued for a total of six cycles or until tumor progression or unacceptable toxicity. Primary end point was best overall response rate; secondary end points were progression-free survival, overall survival, and toxicity.
  • 摘要：1 脑瘤化疗药物概况 恶性脑瘤约占颅内肿瘤50％左右．其中以恶性胶质瘤为主。按WHO分类，Ⅰ级为良性肿瘤，Ⅱ级为低度恶性肿瘤，Ⅲ～Ⅳ级为恶性肿瘤。目前。恶性脑瘤大多主张手术联合放疗和化疗等综合治疗。手术是恶性脑瘤的重要治疗手段．但其浸润性生长的特性使得手术常常无法根治性全切肿瘤。手术后辅助放疗可以提高治疗效果．但相当一部分脑瘤对放疗不敏感，且存在放射剂量的限制。
  • 摘要：BACKGROUND & OBJECTIVE: Low-grade gliomas grow in an infdtrative manner. Surgery is the mainstay in the treatment of low-grade gliomas. In this article, we investigated the role of neuronavigation system in the resection of supratentorial low-grade gliomas. METHODS: Eighty-four patients were treated with neumnavigation-aasisted neurasurgery in our hospital from June 2007. The advanstage of neuronavigation system in the treatment of low-grade glinmas was assessed. RESULTS: Of our cases,the mean registration error was 1.6～2.9 mm. According to the imaging data,total lesion removal was achieved in all cases. The clinic status was improved in 76 cases, stable in 7 cases and deteriated in 1 case but improved quickly. CONCLUSION: Neuronavigation system facilitates to locate the tumor and determine the scope of surgical resection, which is helpful to remove the tumor totally and decrease the incidence of surgical complications.%背景与目的:低级别胶质瘤在影像学上表现为界限不清,目前治疗仍以手术为主,本研究利用神经导航精确定位的优势,探讨神经导航系统在幕上低级别脑胶质瘤手术中的价值.方法:收集哈尔滨医科大学附属肿瘤医院应用神经导航系统辅助切除幕上低级别脑胶质瘤84例临床资料,并对神经导航应用于低级别脑胶质瘤切除手术的优越性、精确性和注意事项进行分析和总结.结果:本组病例中平均注册误差为1.6～2.9mm,术后近期复查MRI证实全组病例均达到影像学全切除.术后症状改善76例(95%);症状无改善7例;加重1例,且在短时间内恢复.结论:神经导航系统可以精确定位并确定手术切除范围,有利于幕上低级别脑胶质瘤的全切除率及降低手术并发症的发生.
  • 摘要：背景与目的:垂体腺瘤手术分为经蝶和经颅入路两种,常根据不同的情况选择合适的手术入路,这与肿瘤的全切除程度和术后疗效密切相关.本研究探讨经单鼻孔-蝶窦及双额底入路治疗垂体腺瘤的手术适应证、显微外科技术及疗效.方法:回顾性分析47例垂体腺瘤手术患者,其中经单鼻孔-蝶窦手术30例,经双侧额底人路手术17例,分析手术经过、治疗效果和随访情况.结果:肿瘤总体全切率89.36%(43/47),其中经单鼻孔-蝶窦入路组86.67%(26/30),经双额底入路组94.12%(16/17).肿瘤未获全切者术后辅以放射治疗.随访6～24个月,4例患者肿瘤复发,接受经双额底入路手术后恢复良好.结论:经单鼻孔-蝶窦入路手术治疗垂体腺瘤创伤小、恢复快,适用于肿瘤大部分位于鞍内或向蝶窦生长的患者.经双额底入路肿瘤全切率高,便于保护垂体柄,适用于肿瘤主要向鞍上及鞍旁生长的大型或巨大型肿瘤.%BACKGROUND&OBJECTIVE: Pituitary adenomas were commonly removed through the transsphenoidal or transcranial approach. The ideal operative approach should be based on clinical history and radiological data, which was associated with the resection extent and prognosis. In this study, we investigated the operative indications, microsurgical skills and efficacy of transsphenoidal and transcranial approach to remove pituitary adenomas. METHODS: According to the different growing manner of pituitary adenomas, 30 cases were treated through the tramsphenoidal approach and 17 via the trans-subfront bilateral approach. RESULTS: The total resection rate of pituitary adenomas through the two approaches was 89.36% (43/47). The total resection rate of transsphenoidal operation was 86.67% (26/30), and that of transeranial operation was 94.12% (16/17). All the patients were followed up for 6-24 months. Tumors recurred in 4 cases in transcranial approach treated group and were then re-operated via the transeranial approach. CONCLUSION: The transsphenoidal approach is ideal to remove adenomas growing towards the sphenoidal sinus and inner saddle region while transcranial approach is suitable for large or giant adenomas growing towards the upper saddle region and parasaddle.
  • 摘要：BACKGROUND & OBJECTIVE: To maintain the anatomic and functional intactness of facial nerve is one of the goal of acoustic neuroma resection. In this article, we investigated the role of intraoperative facial nerve monitoring in acoustic neuroma resection. METHODS: Clinical data of 57 patients with acoustic neuroma treated in our hospital were retrospectively analyzed. Among 57 patients, tumors were removed under microscope without intranperative facial nerve monitoring in 35 cases and with intraoperative monitoring in 22 cases. Post operative facial nerve function was followed up in all patients. RESULTS: House-Brackmann system was used for evaluating the function of facial nerve 3 months after operation. Among 22 cases with intraoperative facial nerve monitoring, facial nerve intactness was observed in 18 cases, Grade Ⅰ facial paralysis in 2 cases and Grade Ⅱ facial paralysis in 2 cases, repectively. The monitoring group had 2 cases Among 35 cases without intracperative facial nerve monitoring, intact faical function was observed in 14 cases, Grade Ⅰfacial paralysis in 12 cases, Grade Ⅱ facial paralysis in 6 cases, grade Ⅲ facial paralysis in 2 cases, and Grade Ⅴ facial paralysis in 1 case, respectively.Patients with intraoperative facial nervemonitoring had better performance in facial nerve function than those without monitoring (P< 0.05). CONCLUSION: Intraoperative nerve monitoring techniques facilitates the localization and preservation of the facial nerve in acoustic neuroma resection.%背景与目的:面神经瘫痪是听神经瘤切除术中最常见的并发症,近年来随着术中神经监测技术的应用,术后面神经功能已得到较好的保护.本研究旨在探讨术中神经监测在听神经瘤手术中对面神经功能的保护作用.方法:分析本院收治手术的57例听神经瘤患者,其中直接显微镜下切除肿瘤(非监测组)35例,显微镜下切除肿瘤过程中使用术中神经监测仪对面神经进行监测(监测组)22例.观察术中面神经实时监测情况,随访所有患者术后面神经功能.结果:术后3个月患者面瘫情况按House-Brackmann面神经功能分级(Ⅰ～Ⅵ级)进行评价,监测组Ⅱ级2例,Ⅲ级2例,其余均无面神经功能异常(Ⅰ级);未监测组Ⅱ级9例,Ⅲ级6例,Ⅳ级2例,Ⅵ级1例,无面神经功能异常者(Ⅰ级)17例.监测组面神经功能保护良好率明显高于未监测组(P<0.05).结论:术中神经监测技术可以提前发现面神经的可能位置,辨别面神经,决定粘连于面神经上肿瘤的剥离程度,判断术中面神经功能的保存情况,明显降低面瘫率,对听神经瘤手术的面神经保护有着积极作用.

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