Dellaretti Marcos, Touzet Gustavo, Reyns Nicolas, Dubois François, Gusmão Sebastião, Pereira Júlio Leonardo Barbosa, Blond Serge
Department of Neurosurgery, CHRU Hôpital Roger Salengro, Lille, France.
J Neurosurg Pediatr. 2011 Dec;8(6):539-43. doi: 10.3171/2011.9.PEDS1167.
The aim of this study was to compare MR imaging characteristics with histopathological findings of intrinsic brainstem lesions and also to show the prognostic factors in patients with diffuse brainstem glioma.
Between February 1988 and August 2007, 44 brainstem biopsies were performed at the Roger Salengro Hospital in Lille, France, in children with intrinsic brainstem lesions not amenable to excision. Twenty-six were female and 18 male, and the mean age was 6 years.
Histological evaluation revealed diffuse brainstem glioma in all patients with diffuse nonenhancing brainstem lesions. Diffuse brainstem glioma was found in 18 patients (90%) with diffuse enhancing brainstem lesions. Pathological entities different from diffuse glioma were verified in 2 patients (10%)-1 with ependymoma and 1 with ganglioglioma. In 4 of 5 patients with a focal nonenhancing brainstem lesion, the histopathological diagnosis was diffuse low-grade glioma. In 6 of 10 patients with focal enhancing brainstem lesion, the diagnosis was diffuse brainstem glioma, and pathological entities different from diffuse brainstem glioma were verified in 2 (20%), both with pilocytic astrocytoma. The mean 1-year actuarial survival rates for patients classified with low-grade and high-grade glioma were 80.4% ± 0.08% and 48.6% ± 0.14%, respectively.
The impact of stereotactic biopsy on intrinsic brainstem lesions was greater in patients with MR imaging-documented enhancing lesions in whom the diagnosis of diffuse glioma was less frequent. Patients with low-grade glioma seem to have longer survival than those with high-grade glioma.
本研究旨在比较脑干原发性病变的磁共振成像特征与组织病理学结果，并揭示弥漫性脑干胶质瘤患者的预后因素。
1988年2月至2007年8月期间，法国里尔的罗杰·萨伦格罗医院对44例无法切除的脑干原发性病变儿童进行了脑干活检。其中女性26例，男性18例，平均年龄为6岁。
组织学评估显示，所有脑干弥漫性无强化病变的患者均为弥漫性脑干胶质瘤。18例（90%）脑干弥漫性强化病变的患者被诊断为弥漫性脑干胶质瘤。2例（10%）患者证实为与弥漫性胶质瘤不同的病理实体——1例为室管膜瘤，1例为神经节胶质瘤。5例脑干局灶性无强化病变的患者中，4例组织病理学诊断为弥漫性低级别胶质瘤。10例脑干局灶性强化病变的患者中，6例诊断为弥漫性脑干胶质瘤，2例（20%）证实为与弥漫性脑干胶质瘤不同的病理实体，均为毛细胞型星形细胞瘤。低级别和高级别胶质瘤患者的1年精算生存率分别为80.4%±0.08%和48.6%±0.14%。
立体定向活检对磁共振成像显示有强化病变、弥漫性胶质瘤诊断不常见的脑干原发性病变患者影响更大。低级别胶质瘤患者的生存期似乎比高级别胶质瘤患者更长。
