Fukami Shinjiro, Nakajima Nobuyuki, Okada Hirofumi, Akimoto Jiro, Miki Tamotsu, Fukuhara Hirokazu, Shishido-Hara Yukiko, Nagao Toshitaka, Tsuda Masumi, Kohno Michihiro
Department of Neurosurgery, Tokyo Medical University, Tokyo, Japan.
Department of Neurosurgery, Tokyo Medical University, Tokyo, Japan.
World Neurosurg. 2018 Jun;114:e366-e377. doi: 10.1016/j.wneu.2018.02.185. Epub 2018 Mar 9.
Removal of midline paraventricular gliomas is difficult because of their deep localization and invasive character, requiring biopsy for pathologic diagnosis. This study aimed to assess the pathologic findings and clinical course of midline paraventricular gliomas diagnosed using a neuroendoscope.
This study was performed as a retrospective investigation using a neuroendoscope of 26 patients whose tumors were diagnosed as midline paraventricular gliomas. The main loci of the lesions were the thalamus (11 patients), tectum (6 patients), and other areas (9 patients). Of these 26 patients, 21 (81%) had accompanying obstructive hydrocephalus. Surgery was performed via the lateral ventricle using a flexible scope. For patients with obstructive hydrocephalus, we added endoscopic third ventriculostomy, septostomy, and/or plasty of the foramen of Monro. Pathologic diagnosis was determined according to hematoxylin-eosin staining and immunohistochemistry using anti-GFAP, anti-Ki-67, anti-H3-K27M, and anti-IDH1-R132H antibodies.
The pathologic diagnoses were grade I (5 patients), grade II (3 patients), grade III (6 patients), and grade IV (4 patients) gliomas. Six patients were diagnosed as having high-grade glioma, which was difficult to distinguish between grade III and grade IV. Two patients were undiagnosable. H3-K27M was strongly positive in 8 of 15 patients with high-grade glioma. All patients with high-grade gliomas died or received best supportive care within 2 years after surgery.
Neuroendoscopic surgery is useful for midline paraventricular gliomas in terms of the treatment of obstructive hydrocephalus, as well as pathologic diagnosis and genetic analysis, which are required under the World Health Organization 2016 classification.
中线室旁胶质瘤因其位置深且具有浸润性，难以完全切除，需要活检以进行病理诊断。本研究旨在评估使用神经内镜诊断的中线室旁胶质瘤的病理结果和临床病程。
本研究采用回顾性调查方法，对26例经神经内镜诊断为中线室旁胶质瘤的患者进行研究。病变的主要部位为丘脑（11例）、顶盖（6例）和其他区域（9例）。这26例患者中，21例（81%）伴有梗阻性脑积水。使用软性内镜经侧脑室进行手术。对于伴有梗阻性脑积水的患者，我们增加了内镜下第三脑室造瘘术、透明隔造瘘术和/或室间孔成形术。根据苏木精-伊红染色以及使用抗GFAP、抗Ki-67、抗H3-K27M和抗IDH1-R132H抗体的免疫组织化学检查确定病理诊断。
病理诊断为I级胶质瘤5例、II级胶质瘤3例、III级胶质瘤6例、IV级胶质瘤4例。6例被诊断为高级别胶质瘤，难以区分III级和IV级。2例无法明确诊断。15例高级别胶质瘤患者中有8例H3-K27M呈强阳性。所有高级别胶质瘤患者在术后2年内死亡或接受最佳支持治疗。
神经内镜手术对于中线室旁胶质瘤在治疗梗阻性脑积水以及进行病理诊断和基因分析方面是有用的，而这些是世界卫生组织2016年分类所要求的。
