Baussart B, Lepeintre J-F, Condette-Auliac S, Dupuy M, Gaillard S
Service de neurochirurgie, hôpital Foch, 40, rue Worth, 92150 Suresnes, France.
Neurochirurgie. 2007 Feb;53(1):43-6. doi: 10.1016/j.neuchi.2006.11.005.
A 22-year-old man presented headache, asthenia, body weight loss and trigeminal hypoesthesia worsening quickly. Radiological analysis showed an enhanced lesion that originated from the cavernous sinus and extended into the Meckel cave, owing to the fifth cranial nerve's course. The lesion was explored by a temporo-pterional approach and was partially removed. On the basis of histological analysis and negativity of tumor marker levels in serum and cerebrospinal fluid (alpha-fetoprotein alpha, human beta-chorionic gonadotropin), a primitive non-secreting intracranial germinoma was diagnosed. Under combined chemotherapy (carboplatine, ifosfamide, etoposide) followed by focal fractionated radiotherapy delivering 40 Gy to the initial tumor volume, the outcome was excellent. Five years later, the patient was in complete clinical and radiological remission. Primitive intracranial germinomas are rare malignant tumors involving mainly pineal and hypothalamic regions. We report a case of intracranial trigeminal nerve germinoma. To the best of our knowledge, no case of primitive germinoma was previously described in this location. Aspects of diagnosis and treatment are discussed in the light of previous publishing data.
一名22岁男性出现头痛、乏力、体重减轻以及三叉神经感觉减退且迅速加重。影像学分析显示一个强化病灶,该病灶起源于海绵窦并因第五颅神经走行而延伸至梅克尔腔。通过颞翼点入路对病灶进行探查并部分切除。基于组织学分析以及血清和脑脊液中肿瘤标志物水平呈阴性(甲胎蛋白、人β绒毛膜促性腺激素),诊断为原发性非分泌性颅内生殖细胞瘤。在接受联合化疗(卡铂、异环磷酰胺、依托泊苷),随后对初始肿瘤体积给予40 Gy的局部分次放疗后,结果良好。五年后,患者临床和影像学完全缓解。原发性颅内生殖细胞瘤是罕见的恶性肿瘤,主要累及松果体区和下丘脑区。我们报告一例颅内三叉神经生殖细胞瘤。据我们所知,此前该部位未描述过原发性生殖细胞瘤病例。结合既往发表的数据对诊断和治疗方面进行了讨论。