Qi Songtao, Fan Jun, Zhang Xi-an, Zhang Hui, Qiu Binghui, Fang Luxiong
Department of Neurosurgery, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Dadao Bei Street, Guangzhou, 510515, People's Republic of China,
Acta Neurochir (Wien). 2014 Dec;156(12):2253-62. doi: 10.1007/s00701-014-2224-4. Epub 2014 Sep 23.
The role of radical resection for nongerminomatous pineal region tumors is still controversial. The purpose of this study was to present the surgical results in a large series and evaluate the feasibility of radical surgical strategy.
We retrospectively reviewed the records of 143 patients with nongerminomatous pineal region tumors surgically treated via an occipital transtentorial approach between 2000 and 2011. The tumor was small (<2 cm) in 14.7 % of patients, medium (2-4 cm) in 52.4 %, and large (>4 cm) in 32.9 %.
Gross total tumor removal was achieved in 91.6 % of patients, subtotal in 7.0 %, and partial in 1.4 %. Histological diagnosis was nongerminomatous germ cell tumor in 41.3 %, pineal parenchymal tumor in 14.7 %, glial tumors in 28.7 %, and miscellaneous in 15.4 %. The overall complication and mortality rate was 18.2 % and 0.7 %, respectively. Permanent morbidity occurred in 5.6 % of patients, including hemianopsia in 3.5 % and Parinaud syndrome in 2.1 %. Hydrocephalus was resolved in 82.1 % without surgery for the CSF diversion. Sixty-eight patients with malignant tumors underwent radiotherapy; 35 also received adjuvant chemotherapy. One hundred thirty patients were successfully followed up with a mean duration of 43 months. Finally, 86.9 % of the patients achieved a favorable functional outcome (mRS ≤ 2), 3.1 % had an mRS score of 3, 1.5 % had an mRS score of 4, and 8.5 % had died (mRS = 6).
Radical surgery was recommended as the optimal treatment for nongerminomatous pineal region tumors. Favorable results could be achieved by experienced neurosurgeons. Hydrocephalus could be cured by radical tumor removal in the majority of cases. The occipital transtentorial approach was indicated for most pineal region tumors, but surgeon's preference and experience should also be considered. New understanding of the arachnoid membranes of this region may be helpful for tumor resection.
根治性切除术在非生殖细胞性松果体区肿瘤中的作用仍存在争议。本研究的目的是呈现大量病例的手术结果，并评估根治性手术策略的可行性。
我们回顾性分析了2000年至2011年间经枕下经小脑幕入路手术治疗的143例非生殖细胞性松果体区肿瘤患者的病历。14.7%的患者肿瘤较小（<2 cm），52.4%的患者肿瘤中等大小（2 - 4 cm），32.9%的患者肿瘤较大（>4 cm）。
91.6%的患者实现了肿瘤全切除，7.0%的患者为次全切除，1.4%的患者为部分切除。组织学诊断为非生殖细胞性生殖细胞瘤的占41.3%，松果体实质肿瘤占14.7%，神经胶质瘤占28.7%，其他占15.4%。总体并发症发生率和死亡率分别为18.2%和0.7%。5.6%的患者出现永久性神经功能障碍，包括3.5%的患者出现偏盲，2.1%的患者出现Parinaud综合征。82.1%的患者脑积水未经脑脊液分流手术即得到缓解。68例恶性肿瘤患者接受了放疗；35例还接受了辅助化疗。130例患者成功获得随访，平均随访时间为43个月。最后，86.9%的患者获得了良好的功能预后（改良Rankin量表评分≤2），3.1%的患者评分为3，1.5%的患者评分为4，8.5%的患者死亡（改良Rankin量表评分 = 6）。
推荐根治性手术作为非生殖细胞性松果体区肿瘤的最佳治疗方法。经验丰富的神经外科医生可取得良好的治疗效果。在大多数情况下，通过根治性肿瘤切除可治愈脑积水。大多数松果体区肿瘤适合采用枕下经小脑幕入路，但也应考虑术者的偏好和经验。对该区域蛛网膜的新认识可能有助于肿瘤切除。
