Nelson Andrew J, Zakaria Rasheed, Jenkinson Michael D, Brodbelt Andrew R
a Department of Neurosurgery , The Walton Centre NHS Foundation Trust , Lower Lane , Liverpool , UK.
b Institute of Translational Medicine , University of Liverpool , Liverpool , UK.
Br J Neurosurg. 2019 Jun;33(3):343-347. doi: 10.1080/02688697.2018.1549315. Epub 2019 Jan 17.
Pilocytic astrocytomas are rare tumours in adults. Presentation, management and prognostic factors are poorly characterised. Retrospective single centre study from 2000 to 2016. 50 cases were identified (median age 29 years; range 16-76). Symptoms at presentation were neurological deficit ( = 21), headache ( = 18) and seizures ( = 6). Five were incidental findings. Five patients had hydrocephalus at presentation and required emergent management, two by endoscopic third ventriculostomy and three by external ventricular drain. Symptoms were present for a median of 16 weeks (range 1 week to 34 years). Surgery consisted of gross total resection ( = 23), subtotal resection ( = 21) or biopsy ( = 6). Progression occurred in 20 patients at a median time of 7 years following surgery and was asymptomatic in just over half of these cases. A greater degree of resection (complete vs. subtotal) was associated with longer time to progression (Kaplan-Meier analysis, log rank test = 3.58, = 0.059). At their first progression 12 patients underwent re-resective surgery and the remainder received radiotherapy. The median 5-year survival was 80%. In adult patients with a pilocytic astrocytoma, a macroscopic resection should be the aim at the first resective operation. Emergency management of hydrocephalus may be required in the first instance.
毛细胞型星形细胞瘤在成人中较为罕见。其临床表现、治疗方法及预后因素目前尚不明确。这是一项对2000年至2016年期间单中心病例的回顾性研究。共纳入50例患者（中位年龄29岁；范围16 - 76岁）。就诊时的症状包括神经功能缺损（21例）、头痛（18例）和癫痫发作（6例）。5例为偶然发现。5例患者就诊时伴有脑积水，需要紧急处理，其中2例行内镜下第三脑室造瘘术，3例行脑室外引流术。症状出现的中位时间为16周（范围1周至34年）。手术方式包括全切除（23例）、次全切除（21例）或活检（6例）。20例患者术后出现进展，进展的中位时间为7年，其中略多于半数的病例进展时无症状。切除程度越高（全切与次全切相比），进展时间越长（Kaplan - Meier分析，对数秩检验 = 3.58，P = 0.059）。首次进展时，12例患者接受了再次切除手术，其余患者接受了放疗。5年生存率的中位数为80%。对于成年毛细胞型星形细胞瘤患者，首次切除手术应争取达到肉眼下全切。首先可能需要对脑积水进行紧急处理。
