Kawashima Ayako, Sasajima Toshio, Sugawara Taku, Takahashi Masataka, Suzuki Akira, Higashiyama Naoki, Kinouchi Hiroyuki, Mizoi Kazuo
Department of Neurosurgery, Akita University School of Medicine, 1-1-1 Hondo, Akita-city 010-8543, Japan.
No Shinkei Geka. 2004 Sep;32(9):937-44.
We reported a rare case of cervical glioblastoma with intracranial dissemination at an early stage of clinical course and reviewed the literature. An 8-year-old girl presented with failure of vision 3 months prior to admission to our hospital. Neurological examination on admission disclosed no definitive abnormalities except for bilateral visual disturbance and optic atrophy. Cranial MR images revealed a homogeneously enhancing tumor in the left sylvian fissure. Multiple spotty T2-hyperintensity lesions without contrast enhancement were also disclosed in bilateral cerebellum. Spinal MR images showed an enhancing tumor at C7 and tiny enhancing lesions on the surface of T11. The patient underwent an uneventful excision of the exophytic tumor at C7. The histological diagnosis was glioblastoma. The enhancing tumor in the left sylvian fissure treated by Linac stereotactic radiotherapy with a marginal dose of 38.4Gy in 12 fractions has diminished, whereas the residual tumor at C7 remained unchanged after radiation of 44Gy. In contrast, the multiple spotty lesions without contrast enhancement dispersedly spread in the cerebellum and infiltrated into brain stem despite 4 courses of chemotherapy using ifosfamide, cisplatin, and etoposide. Stereotactic biopsy of the multiple spotty lesions in the cerebellum was performed. Histological examination revealed anaplastic astrocytoma. The patient died 2 weeks after the biopsy despite additional chemotherapy and focal irradiation to the cerebellum. Early detection and selection of optimal therapeutic strategies are important in management of spinal glioblastoma with subarachnoid dissemination, since neuroradiological findings and therapeutic sensitivity are varied according to differentiation of disseminated tumors.
我们报告了一例罕见的颈段胶质母细胞瘤，在临床病程早期即发生颅内播散，并对相关文献进行了回顾。一名8岁女孩在入院前3个月出现视力减退。入院时神经系统检查除双侧视力障碍和视神经萎缩外未发现明确异常。头颅磁共振成像显示左侧外侧裂有一均匀强化的肿瘤。双侧小脑还发现多个无强化的斑点状T2高信号病变。脊柱磁共振成像显示C7水平有一强化肿瘤，T11椎体表面有微小强化病变。患者顺利切除了C7水平的外生性肿瘤。组织学诊断为胶质母细胞瘤。对左侧外侧裂强化肿瘤采用直线加速器立体定向放射治疗，边缘剂量38.4Gy，分12次照射，肿瘤已缩小，而C7水平的残留肿瘤在44Gy放疗后无变化。相比之下，尽管使用异环磷酰胺、顺铂和依托泊苷进行了4个疗程的化疗，小脑内多个无强化的斑点状病变仍分散扩散并侵犯脑干。对小脑内多个斑点状病变进行了立体定向活检。组织学检查显示为间变性星形细胞瘤。尽管对小脑进行了额外化疗和局部照射，患者在活检后2周死亡。对于伴有蛛网膜下腔播散的脊髓胶质母细胞瘤，早期发现并选择最佳治疗策略很重要，因为神经放射学表现和治疗敏感性会因播散肿瘤的分化程度而异。
