采用“扩展”经鼻内镜入路切除鞍内-鞍上混合型生殖细胞瘤：技术病例报告
The "extended" endoscopic endonasal approach for the removal of a mixed intrasuprasellar germinoma: Technical case report.
作者信息
Somma Alberto Di, Bronzoni Carolina, Guadagno Elia, Solari Domenico, Dell'aversana Giovanni Orabona, De Caro B S Marialaura Del Basso, Cappabianca Paolo
机构信息
Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy.
Department of Advanced Biomedical Sciences, Division of Pathology, Università degli Studi di Napoli Federico II, Naples, Italy.
出版信息
Surg Neurol Int. 2014 Jan 29;5:14. doi: 10.4103/2152-7806.126043. eCollection 2014.
BACKGROUND
Intracranial germ cell tumors (GCTs) represent less than 5% of pediatric brain tumors. Neurosurgical treatment remains essential in the management of patients with intracranial nongerminomatous GCT.
CASE DESCRIPTION
A 12-year-old girl presented with clinical features of neurohypophyseal dysfunction and rapidly progressive visual worsening. Magnetic resonance imaging (MRI) showed a lesion arising from the sella with a significant suprasellar component, compressing the optic chiasm and extending into the third ventricle. The tumor was removed via an endoscopic endonasal transtuberculum-transplanum approach and the histology revealed a mixed germinoma. In the postoperative course, a conspicuous improvement of visual function was observed; an early postoperative MRI showed near-total removal of the lesion. The patient was referred to pediatric oncologist for the adjunctive chemotherapy and radiotherapy.
CONCLUSIONS
The management of primary intracranial sellar and suprasellar germinomas still remains controversial. With this report we highlighted another possible surgical option among therapeutic strategies for these highly malignant tumors.
背景
颅内生殖细胞肿瘤（GCTs）占小儿脑肿瘤的比例不到5%。神经外科治疗在颅内非生殖细胞瘤患者的管理中仍然至关重要。
病例描述
一名12岁女孩出现神经垂体功能障碍的临床特征及视力迅速恶化。磁共振成像（MRI）显示病变起源于蝶鞍，并有明显的鞍上成分，压迫视交叉并延伸至第三脑室。通过内镜经鼻经结节 - 经筛板入路切除肿瘤，组织学检查显示为混合性生殖细胞瘤。在术后过程中，观察到视力功能有明显改善；术后早期MRI显示病变几乎完全切除。患者被转诊至儿科肿瘤学家处进行辅助化疗和放疗。
结论
原发性颅内蝶鞍和鞍上生殖细胞瘤的管理仍存在争议。通过本报告，我们强调了这些高度恶性肿瘤治疗策略中另一种可能的手术选择。
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