Vertosick F T, Selker R G
Department of Neurosurgery, University of Pittsburgh School of Medicine, Pennsylvania.
Neurosurgery. 1990 Oct;27(4):516-21; discussion 521-2. doi: 10.1097/00006123-199010000-00002.
Although the spread of supratentorial glioblastoma multiforme to the brain stem and spine has been extensively described in published autopsy series, information on the diagnosis, treatment, and subsequent clinical course of patients manifesting symptoms of glioblastomatous dissemination ante mortem remains scant. We report a series of 11 patients having the signs and symptoms of neuraxis dissemination of supratentorial glioblastoma multiforme. All patients had radiographic documentation of metastases by either contrast-enhanced myelograms or enhanced magnetic resonance imaging scans. Ten presented with spinal involvement, whereas one presented with lower cranial neuropathies secondary to diffuse involvement of the basal cisterns. The mean age of the patients was 38.5 years, and the mean time interval between diagnosis of intracranial disease and diagnosis of metastases was 14.1 months. After diagnosis of tumor spread, subsequent mean survival time was 2.8 months. All patients received additional radiotherapy to the areas of metastasis, but the clinical response to radiotherapy was quite poor. This study confirms previous reports in the literature suggesting that metastases occur in younger patients and in patients with extended survival. The findings suggest that the relatively infrequent clinical incidence of the symptomatic spread of glioblastoma multiforme, as compared with the frequent incidental discovery of such spread at autopsy, may be the result of the limited survival of the affected patients, and not due to the biology of the tumor.
尽管幕上多形性胶质母细胞瘤向脑干和脊柱的播散在已发表的尸检系列中已有广泛描述，但关于生前出现胶质母细胞瘤播散症状的患者的诊断、治疗及后续临床病程的信息仍然匮乏。我们报告了一系列11例具有幕上多形性胶质母细胞瘤神经轴播散体征和症状的患者。所有患者均通过对比增强脊髓造影或增强磁共振成像扫描获得了转移灶的影像学记录。10例表现为脊髓受累，1例表现为由于基底池弥漫性受累继发的低位颅神经病变。患者的平均年龄为38.5岁，颅内疾病诊断与转移灶诊断之间的平均时间间隔为14.1个月。在诊断肿瘤播散后，随后的平均生存时间为2.8个月。所有患者均接受了转移灶区域的额外放疗，但放疗的临床反应相当差。本研究证实了文献中先前的报道，提示转移发生在较年轻的患者和生存期延长的患者中。这些发现表明，与尸检时频繁偶然发现胶质母细胞瘤播散相比，其有症状播散的临床发生率相对较低，可能是由于受累患者生存期有限，而非肿瘤生物学特性所致。
