Oda Yuichi, Amano Kosaku, Chiba Kentaro, Masui Kenta, Kawamata Takakazu
Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan.
Department of Pathology, Tokyo Women's Medical University, Tokyo, Japan.
NMC Case Rep J. 2023 Oct 14;10:285-289. doi: 10.2176/jns-nmc.2023-0107. eCollection 2023.
As per the 2021 World Health Organization (WHO) Classification of Tumors of the Central Nervous System, chordoid glioma (CG) is defined as a slow-growing glial neoplasm categorized as grade II tumor. This tumor is primarily located in the anterior part of the third ventricle, often adheres to important surrounding structures, and is hemorrhagic in nature. Therefore, dissecting this tumor is extremely difficult. In this study, we present the case of a 44-year-old man who initially complained of mild headache and was diagnosed with a homogeneous gadolinium-enhanced lesion in the third ventricle via magnetic resonance imaging. The pathological diagnosis based on his biopsy at the previous hospital was CG. The patient demonstrated no neurological deficit at that time, but the tumor had gradually grown, hydrocephalus appeared 2 years after the tumor was detected, and the patient developed short memory disorder and daytime sleepiness. We resected the tumor via the anterior interhemispheric trans-lamina terminalis approach using a microscope and an endoscope. The residual tumor at the blind spot of the microscopic view was resected under an angled rigid endoscopic view using dedicated tools for transsphenoidal surgery. The tumor was grossly resected, and the histopathological diagnosis was CG. Postoperative neurological findings included slight memory disorder and hypothalamic adrenal dysfunction. No tumor recurrence was reported 3 years post resection. The endoscope-assisted anterior interhemispheric trans-lamina terminalis approach was determined useful for CG resection with minimal surgical complications and without tumor recurrence.
根据2021年世界卫生组织（WHO）中枢神经系统肿瘤分类，脊索样胶质瘤（CG）被定义为一种生长缓慢的神经胶质肿瘤，属于二级肿瘤。该肿瘤主要位于第三脑室前部，常与周围重要结构粘连，且具有出血性。因此，切除这种肿瘤极其困难。在本研究中，我们报告了一例44岁男性病例，该患者最初主诉轻度头痛，通过磁共振成像被诊断为第三脑室内均匀钆增强病变。根据其在前一家医院活检的病理诊断为CG。当时患者无神经功能缺损，但肿瘤逐渐生长，在肿瘤被发现2年后出现脑积水，患者出现短期记忆障碍和日间嗜睡。我们通过显微镜和内镜经前纵裂经终板入路切除肿瘤。在显微镜视野盲区的残留肿瘤在成角硬镜视野下使用经蝶窦手术专用工具切除。肿瘤被大体切除，组织病理学诊断为CG。术后神经学表现包括轻微记忆障碍和下丘脑肾上腺功能障碍。切除术后3年未报告肿瘤复发。内镜辅助经前纵裂经终板入路被确定对CG切除有用，手术并发症最少且无肿瘤复发。
