Serova N K, Butenko E I, Konovalov A N, Grigor'eva N N, Pitskhelauri D I, Abramov I T, Danilov G V
Burdenko Neurosurgical Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047.
Zh Vopr Neirokhir Im N N Burdenko. 2018;82(3):42-47. doi: 10.17116/neiro201882342.
The most common clinical manifestations of space-occupying lesions of the midbrain and pineal region are oculomotor and pupil disorders and ophthalmoscopic signs of intracranial hypertension.
To identify patterns of neuro-ophthalmic symptoms before and after surgical treatment in patients with space-occupying lesions of the midbrain and pineal region.
We analyzed neurological symptoms in 231 patients with space-occupying lesions of the midbrain and pineal region before and after surgical treatment. Malignant tumors were detected in 121 patients; benign tumors were present in 73 patients; 37 patients were diagnosed with pineal gland cysts. Patients with suspicion of germinoma underwent a tumor biopsy only; the other patients underwent tumor resection.
Before surgery, oculomotor and pupil disorders were detected in more than half of the (67%) patients; ophthalmoscopic signs of intracranial hypertension were present in 38% of the patients. Neuro-ophthalmic symptoms significantly more often occurred in patients with malignant tumors. Midbrain symptoms were significantly more pronounced in germ cell tumors than in other malignant neoplasms. In the early postoperative period after tumor resection, deterioration of oculomotor and pupillary functions occurred in 46% of cases; there were no changes in 51% of cases; improvement occurred in 3% of cases. After tumor biopsy, symptoms in all patients with germinomas remained at the preoperative level. Developed symptoms partially regressed in the long-term period, and finally, only 29% of patients had deterioration of oculomotor and pupillary functions compared to the preoperative level.
中脑和松果体区占位性病变最常见的临床表现是动眼神经和瞳孔障碍以及颅内高压的眼底征象。
确定中脑和松果体区占位性病变患者手术治疗前后的神经眼科症状模式。
我们分析了231例中脑和松果体区占位性病变患者手术治疗前后的神经症状。121例患者检测出恶性肿瘤；73例患者存在良性肿瘤；37例患者被诊断为松果体囊肿。疑似生殖细胞瘤的患者仅接受肿瘤活检；其他患者接受肿瘤切除术。
手术前，超过一半（67%）的患者检测出动眼神经和瞳孔障碍；38%的患者存在颅内高压的眼底征象。神经眼科症状在恶性肿瘤患者中出现的频率明显更高。生殖细胞肿瘤患者的中脑症状比其他恶性肿瘤患者明显更明显。在肿瘤切除后的早期术后阶段，46%的病例出现动眼神经和瞳孔功能恶化；51%的病例无变化；3%的病例有所改善。肿瘤活检后，所有生殖细胞瘤患者的症状保持在术前水平。长期来看，出现的症状部分消退，最终，与术前水平相比，只有29%的患者出现动眼神经和瞳孔功能恶化。
