CAJ | 학술논문

目的探求儿童眶内视神经胶质瘤的手术方法.方法总结3例15岁以下(分别是1.5岁、3岁和10岁)眼眶内视神经胶质瘤临床症状和体征,肿瘤影像学发现,采用经额底入路打开前颅底(眶顶),切除视神经肿瘤.根据肿瘤切除程度和患儿年龄采用术后放疗.结果 3例患儿视力下降,2例有下凸眼,患侧瞳孔扩大且无光反射.2例肿瘤向颅内生长其视乳头呈苍白色,1例眶内局限生长视乳头呈水肿改变.MRI和CT显示3例均为右侧眶内肿瘤,呈梭状外观,其中2例肿瘤向颅内生长,但没有超过视交叉.经冠状切口额底入路,去除眶顶板,眶内段肿瘤全部切除3例,其中2例向颅内生长部分没有全切除.术后1例10岁患儿行放疗,另2例为3岁以下患儿,未行放疗.3例患儿术后连续随访,最长8年,均没有肿瘤复发.结论对于局限存眶内段的视神经胶质瘤应予全切除,对4岁以上患儿,如有肿瘤颅内生长,应行术后放疗,患儿可获得长期生存.
목적 탐구인동광내시신경효질류적수술방법.방법 총결3례15세이하(분별시1.5세、3세화10세)안광내시신경효질류림상증상화체정,종류영상학발현,채용경액저입로타개전로저(광정),절제시신경종류.근거종류절제정도화환인년령채용술후방료.결과 3례환인시력하강,2례유하철안,환측동공확대차무광반사.2례종류향로내생장기시유두정창백색,1례광내국한생장시유두정수종개변.MRI화CT현시3례균위우측광내종류,정사상외관,기중2례종류향로내생장,단몰유초과시교차.경관상절구액저입로,거제광정판,광내단종류전부절제3례,기중2례향로내생장부분몰유전절제.술후1례10세환인행방료,령2례위3세이하환인,미행방료.3례환인술후련속수방,최장8년,균몰유종류복발.결론 대우국한존광내단적시신경효질류응여전절제,대4세이상환인,여유종류로내생장,응행술후방료,환인가획득장기생존.
Objective To summarize the experience in the treatment of orbital optic nerve glioma in children. Methods The clinical data of 3 patients with orbital optic nerve glioma diagnosed by CT and MRI, aged 1.5y,3y and 10y were analyzed.The frontal-basal approachs were performed according to the clinical presentations, symptoms and images of CT and MRI.The radiotherapy were given to those undertaking the partial remove of tumors which the patients were older than 4 years. The diagnosis was confirmed by pathology after operation in 3 cases. Follow-up was conducted from 1.5 to 8 years. Results The clinical presentations were decreased vision in 3 cases with mydriasis, exophthalmia in 2.The papilla optica showed pale in two cases with tuomrs intracranial invasion. The papilledema was saw in one case with tumor inside the orbit.The tumors were all in the right orbital on with club-shaped and two of them had an invision with cranial beyond the region of the optic chiasm by CT and MRI scans. We performed total ression in the orbital region and partial remove with the intracranial parts of tumors through frontal-basal approach.One of the 10-years-old patient had the radiotherapy after operation and 2 patients under 3 years old were given medical follow-up observation. The follow-up was conducted for 8 years longest and no recurrence of the tumors was found. Conclusions Resection of orbital optic nerve gliomas via cranial-basal approach is effective, it is suggested to perform total ression of tumor inside the orbital. For the tumors growth towards the cranial, post-operative radiation therapy is recommended when the patients are older than 4 years.