脑中线部位胶质瘤的手术治疗及分子生物学分析
Surgical treatment and molecular biological analysis of patients with glioma in cerebral midline area

目的 探讨脑中线部位胶质瘤切除术的手术策略，并作分子生物学分析。方法 分析脑中线部位胶质瘤患者共28例，均行显微镜下肿瘤切除术，必要时辅助神经内镜。术后留取肿瘤标本，采用PCR检测异柠檬酸脱氢酶-1/2（IDH1/2），6-甲基鸟嘌呤-DNA-甲基转移酶（MGMT）启动子甲基化。采用Kaplan-Meier 分析对所有患者随访生存时间进行统计分析。结果 所有病例术后病理检查提示，毛细胞星形细胞瘤2例(7%)，WHO Ⅱ 级11例 (39%)，WHO Ⅲ 级5例 (19%)及WHO Ⅳ级10 例 (35%)。Kaplan-Meier 分析提示，患者平均总体生存时间为15个月，其中低级别胶质瘤总体生存时间为26个月，而高级别胶质瘤的总体生存时间为9个月，两者相比差异有统计学意义（P<0.01）。术后肿瘤标本应用PCR分析发现，仅有3例(11%)患者发现IDH1/2基因阳性突变，4例患者(14%)MGMT启动子甲基化阳性。 结论 联合多种技术包括神经内镜、术中导航等是改善脑中线部位胶质瘤患者预后的主要方法。
： Objective To explore the operative strategy of resection of gliomas in cerebral midline area and conduct the molecular biological analysis. Methods Data of 28 patients with glioma in cerebral midline area who underwent resection under microscope with the assistance of neuroendoscopy if necessary were analyzed. Tumor samples were stored after operation IDH1/2 mutation and MGMT promoter methylation were detected by PCR. The survival time of all patients was statistically analyzed by Kaplan-Meier analysis. Results Histopathological examination after operation revealed that 2 patients with pilocytic glioma (7%), 11 patients with WHO grade Ⅱ glioma (39%), 5 patients with WHO grade Ⅲ glioma (19%), and 10 patients with WHO grade Ⅳ glioma (35%). Kaplan-Meier analysis indicated that the mean overall survival of all patients was 15 months. The mean overall survivals of patients with low grade glioma and high grade glioma were 26 and 9 months, respectively, and the difference was statistically significant (P<0.01). PCR analysis of tumor samples after operation showed that only 3 patients with positive mutation of IDH1/2 (11%) and 4 patients with positive MGMT promoter methylation (14%). Conclusion Combination of various technologies such as neuroendoscopy and intra-operative navigation is a major method to improve the prognosis of patients with glioma in cerebral midline area