Kanamori Masayuki, Mugikura Shunji, Iizuka Osamu, Mori Naoko, Shimoda Yoshiteru, Shibahara Ichiyo, Umezawa Rei, Jingu Keiichi, Saito Ryuta, Sonoda Yukihiko, Kumabe Toshihiro, Suzuki Kyoko, Endo Hidenori
Department of Neurosurgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi Aoba-ku, Sendai, 980-8574, Japan.
Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan.
J Neurooncol. 2024 Oct;170(1):173-184. doi: 10.1007/s11060-024-04753-9. Epub 2024 Aug 12.
This study identified the factors affecting cerebral microbleed (CMBs) development. Moreover, their effects on intelligence and memory and association with stroke in patients with germinoma who had long-term follow-up were evaluated.
This study included 64 patients with germinoma who were histologically and clinically diagnosed with and treated for germinoma. These patients were evaluated cross-sectionally, with a focus on CMBs on susceptibility-weighted magnetic resonance imaging (SWI), brain atrophy assessed through volumetric analysis, and intelligence and memory.
The follow-up period was from 32 to 412 (median: 175.5) months. In total, 43 (67%) patients had 509 CMBs and 21 did not have CMBs. Moderate correlations were observed between the number of CMBs and time from initial treatments and recurrence was found to be a risk factor for CMB development. Increased temporal CMBs had a marginal effect on the processing speed and visual memory, whereas brain atrophy had a statistically significant effect on verbal, visual, and general memory and a marginal effect on processing speed. Before SWI acquisition and during the follow-up periods, eight strokes occurred in four patients. All of these patients had ≥ 15 CMBs on SWI before stroke onset. Meanwhile, 33 patients with < 14 CMBs or 21 patients without CMBs did not experience stroke.
Patients with a longer time from treatment initiation had a higher number of CMBs, and recurrence was a significant risk factor for CMB development. Furthermore, brain atrophy had a stronger effect on memory than CMBs. Increased CMBs predict the stroke onset.
本研究确定了影响脑微出血（CMB）发生发展的因素。此外，还评估了这些因素对生殖细胞瘤患者长期随访中的智力和记忆的影响以及与中风的相关性。
本研究纳入了64例经组织学和临床诊断为生殖细胞瘤并接受治疗的患者。对这些患者进行横断面评估，重点关注磁敏感加权磁共振成像（SWI）上的CMB、通过体积分析评估的脑萎缩以及智力和记忆。
随访时间为32至412个月（中位数：175.5个月）。总共有43例（67%）患者出现509处CMB，21例未出现CMB。观察到CMB数量与初始治疗后的时间之间存在中度相关性，且复发被发现是CMB发生的一个危险因素。颞叶CMB数量增加对处理速度和视觉记忆有轻微影响，而脑萎缩对语言、视觉和总体记忆有统计学意义的影响，对处理速度有轻微影响。在SWI检查前及随访期间，4例患者发生了8次中风。所有这些患者在中风发作前SWI上均有≥15处CMB。同时，33例CMB数量<14处或21例未出现CMB的患者未发生中风。
从开始治疗起时间较长的患者CMB数量较多，且复发是CMB发生的一个重要危险因素。此外，脑萎缩对记忆的影响比CMB更强。CMB数量增加可预测中风发作。
