Wong Tai-Tong, Chen Hsin-Hung, Liang Muh-Lii, Hsieh Kevin Li-Chun, Yang Yi-Shan, Ho Donald Ming-Tak, Chang Kai-Ping, Lee Yi-Yen, Lin Shih-Chieh, Hsu Ting-Rong, Chen Yi-Wei, Yen Sang-Hue, Chang Feng-Chi, Guo Wan-You, Chen Kuo-Wei, Kwang Wei-Kang, Hou Wu-Yu, Wang Chung-Yih
Department of Neurosurgery, Taipei Medical University Hospital, Taipei Medical University, 252 Wuxing St, Taipei, 11031, Taiwan.
Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital and National Yang Ming University, School of Medicine, Sec 2 Shi Pai Rd, Taipei, 11217, Taiwan.
Childs Nerv Syst. 2016 Oct;32(10):1895-906. doi: 10.1007/s00381-016-3148-5. Epub 2016 Sep 20.
Tumors with epicenter in the thalamus occur in about 4 % of pediatric brain tumors. The histological diagnosis is mainly gliomas. Among them, low-grade glioma (LGG) constituted of a significant entity of the tumors (Cuccia et al., Childs Nerv Syst 13:514-521, 1997; Puget et al., J Neurosurg 106:354-362, 2007; Bernstein et al., J Neurosurg 61:649-656, 1984; Bilginer et al., Childs Nerv Syst 30:1493-1498, 2014). Since Kelly's report in 1989, >90 % resection of thalamic tumors were achieved in reported series (Ozek and Ture, Childs Nerv Syst 18:450-6, 2002; Villarejo et al., Childs Nerv Syst 10:111-114, 1994; Moshel et al., Neurosurgery 61:66-75, 2007; Albright, J Neurosurg 100(5 Suppl Pediatrics): 468-472, 2004; Kelly, Neurosurgery 25:185-195, 1989; Drake et al., Neurosurgery 29: 27-33, 1991).
Sixty-nine cases of thalamic tumors in children were retrospectively reviewed. There were 25 cases of LGGs. We analyzed our experience and correlated it with reported series.
Summing up of 4 reported series and the present series, there were 267 cases of thalamic tumors in children. Among these tumors, 107 (40.1 %) were LGGs and 91 (34.1 %) were low-grade astrocytomas (LGAs). In the present series, all of the 25 LGGs were LGAs that consisted of 11 pilocytic astrocytomas (PAs) and 14 diffuse astrocytomas (DAs). Six cases received biopsy sampling only. The remaining 19 cases received different degrees of surgical resection via several approaches. Radical (>90 %) resection was achieved better in PAs comparing with DAs. There was no operative mortality. Two patients had increased neurological deficits. In a mean follow-up period of 11.9 years, three patients died of tumor progression and one patient died of anaplastic change. The 5- and 10-year overall survival (OS) was 87.1 and 87.1 %, respectively.
Thalamic LGGs are mainly LGAs and are indolent. The rate of >90 % resection was relatively low in the present series. By applying contemporary diagnostic MRI studies, surgical facilities, and appropriate approaches in selective cases, we may try maximum neuroprotective radical (>90 %) resection.
以丘脑为中心的肿瘤约占儿童脑肿瘤的4%。组织学诊断主要为胶质瘤。其中，低级别胶质瘤（LGG）是肿瘤的一个重要组成部分（Cuccia等人，《儿童神经系统》13:514 - 521，1997年；Puget等人，《神经外科杂志》106:354 - 362，2007年；Bernstein等人，《神经外科杂志》61:649 - 656，1984年；Bilginer等人，《儿童神经系统》30:1493 - 1498，2014年）。自1989年凯利的报告以来，在已报道的系列研究中，丘脑肿瘤的切除率>90%（Ozek和Ture，《儿童神经系统》18:450 - 456，2002年；Villarejo等人，《儿童神经系统》10:111 - 114，1994年；Moshel等人，《神经外科学》61:66 - 75，2007年；Albright，《神经外科杂志》100(5增刊儿科版):468 - 472，2004年；凯利，《神经外科学》25:185 - 195，1989年；Drake等人，《神经外科学》29:27 - 33，1991年）。
回顾性分析69例儿童丘脑肿瘤病例。其中低级别胶质瘤25例。我们分析了我们的经验并与已报道的系列研究进行对比。
汇总4个已报道系列和本系列，共有267例儿童丘脑肿瘤。在这些肿瘤中，107例（40.1%）为低级别胶质瘤，91例（34.1%）为低级别星形细胞瘤（LGA）。在本系列中，25例低级别胶质瘤均为低级别星形细胞瘤，包括11例毛细胞型星形细胞瘤（PA）和14例弥漫性星形细胞瘤（DA）。其中6例仅接受活检取样。其余19例通过多种手术入路进行了不同程度的手术切除。与弥漫性星形细胞瘤相比，毛细胞型星形细胞瘤的根治性（>90%）切除效果更好。无手术死亡病例。2例患者神经功能缺损加重。平均随访11.9年，3例患者死于肿瘤进展，1例患者死于间变。5年和10年总生存率分别为87.1%和87.1%。
丘脑低级别胶质瘤主要为低级别星形细胞瘤，生长缓慢。在本系列中，>90%的切除率相对较低。通过应用当代诊断性MRI检查、手术设备以及在选择性病例中采用合适的手术入路，我们可以尝试进行最大限度的神经保护根治性（>90%）切除。
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