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首页> 外文期刊>Neurosurgery >Stereotactic volumetric resection of thalamic pilocytic astrocytomas.
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Stereotactic volumetric resection of thalamic pilocytic astrocytomas.

机译：丘脑毛细血管星形细胞瘤的立体定向容积切除术。

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OBJECTIVE: To describe the surgical approaches, the radiographic and clinical outcomes, and the long-term follow-up of patients harboring thalamic pilocytic astrocytomas after radical resection by means of a stereotactic volumetric technique. METHODS: Seventy-two patients with thalamic pilocytic astrocytomas underwent stereotactic volumetric resection by the senior author (PJK) at the Mayo Clinic between 1984 and 1993 (44 patients) and at New York University Medical Center between 1993 and 2005 (28 patients). Patient demographics, presenting symptoms, surgical approaches, neurological outcomes, pathology, initial postoperative status, and long-term clinical and radiographic follow-up were retrospectively reviewed. RESULTS: On preoperative neurological examinations, 54 of the 72 patients had neurological deficits; of these, 48 had hemiparesis. Postoperative imaging demonstrated gross total resection in 58 patients and minimal (<6 mm) residual tumor in 13 patients. Tumor resection was aborted in one patient. On immediate postoperative examination, 16 patients had significant improvements in hemiparesis. Six patients had worsening of a preexisting hemiparesis and one had a new transient postoperative hemiparesis. There was one postoperative death. After 13 to 20 years of follow-up in the Mayo group (mean, 15 +/- 3 yr) and 1 to 13 years of follow-up in the New York University group (mean, 8 +/- 3 yr), 67 patients were recurrence/progression-free, one had tumor recurrence, and three had progression of residual tumor. There were two shunt-related deaths. On long-term neurological follow-up, 27 patients had significant improvements in hemiparesis; one patient with a postoperative worsening of a preexisting hemiparesis remained unchanged. There were no patients with new long-term motor deficits after stereotactic resection. CONCLUSION: Gross total removal of thalamic pilocytic astrocytomas with low morbidity and mortality can be achieved by computer-assisted stereotactic volumetric resection techniques. Gross total resection of these lesions confers a favorable long-term prognosis without adjuvant chemotherapy and/or radiation therapy and leads to the improvement of neurological deficits.
机译：目的：描述立体定向容积技术在根治性切除后患有丘脑毛细胞星形细胞瘤的患者的手术方法，影像学和临床结果以及长期随访情况。方法：1984年至1993年间，梅奥诊所（44例患者）和1993年至2005年间纽约大学医学中心（28例患者）的资深作者（PJK）对72例丘脑毛细血管星形细胞瘤患者进行了立体定向容积切除术。回顾性地回顾了患者的人口统计资料，表现的症状，手术方法，神经学结果，病理学，术后初始状态以及长期的临床和影像学随访。结果：在术前神经系统检查中，72例患者中有54例存在神经系统缺陷。其中48例患有偏瘫。术后影像学检查显示58例患者全部切除，13例患者残余肿瘤最小（<6 mm）。一名患者中止了肿瘤切除术。术后立即检查，有16例偏瘫患者有明显改善。 6例患者已有既往偏瘫症状加重，而1例患者术后又出现新的短暂偏瘫。术后有1例死亡。 Mayo组的随访时间为13至20年（平均15 +/- 3岁），纽约大学组的随访时间为1至13年（平均8 +/- 3岁），67患者无复发/无进展，一名肿瘤复发，三名残留肿瘤进展。有两例与分流有关的死亡。在长期的神经系统随访中，有27例偏瘫患者有明显改善。一名术后已有偏瘫的病情恶化的患者保持不变。立体定向切除后没有新的长期运动功能障碍的患者。结论：计算机辅助立体定向容积切除技术可完全去除低发病率和高死亡率的丘脑毛细胞星形细胞瘤。这些病变的全切除术可在不进行辅助化学疗法和/或放射治疗的情况下实现良好的长期预后，并改善神经功能缺损。

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