Kobayashi Tatsuya, Tsugawa Takahiko, Hashizume Chisa, Arita Norio, Hatano Hisashi, Iwami Kenichiro, Nakazato Yoichi, Mori Yoshimasa
Nagoya Radiosurgery Center, Nagoya Kyoritsu Hospital, Nagoya, Aichi 454-0933, Japan.
Neurol Med Chir (Tokyo). 2013;53(4):249-55. doi: 10.2176/nmc.53.249.
Chordoid glioma of the third ventricle is considered to be a benign glial tumor located exclusively in the mid-anterior portion of the third ventricle near the hypothalamus and optic nerves, with the histological features of a chordoma and immuno-labeling for glial fibrillary acidic protein. Unfortunately, the clinical outcome of chordoid glioma has been poor, even in patients receiving gross total or partial removal with or without radiotherapy. Three cases of chordoid glioma of the third ventricle were treated with less invasive microsurgery for pathological diagnosis or partial removal without neuro-endocrinological complication, followed by gamma knife radiosurgery using a lower marginal dose for the optic nerves and hypothalamus. Gamma knife radiosurgery was performed after open biopsy in two patients, and after partial removal in the third patient using a lower marginal dose of 10.5 to 12 Gy. Serial magnetic resonance imaging revealed gradual decrease or at least no change in the tumor size, without significant complication at follow up 70 and 66 months later in two cases. The third patient accidentally died 13 months after gamma knife treatment. We conclude that low dose gamma knife radiosurgery after less invasive microsurgery is both safe and effective for the control of chordoid glioma of the third ventricle over a very long follow-up period.
第三脑室脊索样胶质瘤被认为是一种仅位于第三脑室中前部靠近下丘脑和视神经的良性胶质瘤，具有脊索瘤的组织学特征并对胶质纤维酸性蛋白进行免疫标记。不幸的是，即使是接受了全切或部分切除且接受或未接受放疗的患者，第三脑室脊索样胶质瘤的临床预后也很差。3例第三脑室脊索样胶质瘤患者接受了微创显微手术以进行病理诊断或部分切除，未出现神经内分泌并发症，随后对视神经和下丘脑采用较低边缘剂量进行伽玛刀放射外科治疗。2例患者在开放活检后进行了伽玛刀放射外科治疗，第3例患者在部分切除后采用10.5至12 Gy的较低边缘剂量进行治疗。连续磁共振成像显示肿瘤大小逐渐减小或至少没有变化，2例患者在70和66个月后的随访中未出现明显并发症。第3例患者在伽玛刀治疗后13个月意外死亡。我们得出结论，在很长的随访期内，微创显微手术后低剂量伽玛刀放射外科治疗对于控制第三脑室脊索样胶质瘤既安全又有效。
