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。
Objective To investigate the accuracy of preoperative three-dimensional reconstruction of tumor in craniotomy for supratentorial convex brain tumors, and to provide an accurate and safe auxiliary method for craniotomy. Methods Patients with supratentorial convexity brain tumors who were admitted to the Department of Neurosurgery, West China Hospital, Yibin Hospital, Sichuan University between April 2018 and November 2020 were prospectively enrolled and randomly divided into reconstruction group and control group. In the reconstruction group, preoperative three-dimensional reconstruction of the tumor was used for craniotomy positioning, while in the control group, traditional two-dimensional tomographic imaging was used. The basic conditions, intraoperative localization and tumor exposure satisfaction rate, maximum diameter of bone window, operation time, cerebral draining vein injury, and postoperative subcutaneous effusion or intracranial infection were compared between the two groups. Results A total of 43 patients were included, 22 in the reconstruction group and 21 in the control group. There was no significant differences in age, gender composition, incidence of midline shift, tumor growth site and tumor size between the two groups (P>0.05). There was no significant difference in the incidence of cerebral drainage vein injury and postoperative subcutaneous effusion or intracranial infection between the two groups (P>0.05). The satisfaction rate of intraoperative positioning and tumor exposure in the reconstruction group (95.5% vs. 66.7%) was higher than that in the control group, the maximum diameter of the bone window [(6.26±1.32) vs. (7.31±1.13) cm] and the operation time [(194.00±22.76) vs. (214.57±26.53) min] were lower than the control group, and the differences were statistically significant (P<0.05). Conclusions Preoperative three-dimensional reconstruction helps to locate the tumor more accurately, improves the satisfaction rate of tumor exposure, reduces the diameter of the craniotomy window, and shortens the operation time. Compared with traditional two-dimensional tomographic positioning, it has more advantages.
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。