| Objective:Analyze and summarize the characteristics of intracranial germ cell tumors,improve preoperative diagnosis and differential diagnosis;evaluate the safety of stereotactic biopsy in the diagnosis of intracranial germ cell tumors.Methods:1.Case analysis: collecting and sorting in the General Hospital of the People’s Liberation Army from November 2014 to May 2019 The Sixth Medical Center(former Naval General Hospital)neurosurgery visited 115 patients with initial diagnosis of germ cell tumors.All patients underwent stereotactic biopsy,and those with extracranial germ cell tumor metastasis to intracranial patients.A retrospective analysis method was used to analyze its clinical data:(1)pathological results,(2)clinical characteristics,(3)serum tumor markers,(4)imaging characteristics,(5)surgical complications.2.Surgical method: all patients underwent stereotactic biopsy,in which frame stereotactic guidance biopsy 100 For example,CARS-2 frameless stereo guided biopsy in 13 cases and ROSA robot guided biopsy in 2 cases;all biopsy plans(biopsy target selection and puncture path design)were completed with the aid of 3D visualization image planning software.3.Statistical method: SPSS22.0 statistical software analysis:(1)Pass the paired chi-square test,evaluate Valuable serum tumor markers in the diagnosis of intracranial germ cell tumors;(2)By Wilcoxon non-parametric qualitative and test,the difference in electrolyte levels before and after the biopsy of germ cell tumors in the saddle area on day 1 Statistical analysis of the differences in pituitary hormone levels on the 3rd postoperative day.Taking P﹤0.05 as the difference has statistical significance.Results:1.Of 115 patients,112 had a definite pathological diagnosis,3 had no definite pathological diagnosis,and the biopsy positive rate was 97%.Among them,99 cases(86%)of germ cell tumors,92 cases of germ cell tumors,3 cases of yolk sac tumors,2cases of choriocarcinoma,1 case of malignant teratomas and mixed germ cell tumors.13cases(11%)of non-germ cell tumors,6 cases of lesions in the saddle area,including 2cases of optic glioma,Langerhans histiocytosis,1 case of solid craniopharyngioma,and 1case of Rosai-Dorfman.There were 6 cases of pineal region lesions,including 2 cases of glioma and lymphoma,and 1 case of meningioma and pineal blastoma.One case of glioma in basal ganglia.2.(1)99 cases of germ cell tumors,including 76 males and 23 females,male to female ratio 3.3: 1,age 6 ~45 years old,average(20.0 ± 6.1)years old.There were 27 cases in the pineal region,28 cases in the saddle region,14 cases with double lesions in the pineal and saddle region,23 cases of basal ganglia of thalamus,and 7 cases in other locations.Symptoms were 53 cases of intracranial hypertension,40 cases of visual and /or visual disturbances,36 cases of diabetes insipidus,35 cases of hemiplegia,18 cases of pituitary function,16 cases of consciousness disorders,5 cases of eye movement disorders,and other sexual development disorders.Epilepsy,ataxia,etc.(2)13 cases of non-germ cell tumors,6 males and 7 females,aged 7-57 years,average(34 ± 33)years old,6 cases in each of the pineal gland area and saddle area,and 1 case in the basal ganglia area.The main symptoms are intracranial hypertension,visual field disturbance,diabetes insipidus,amenorrhea,disturbance of consciousness,etc.3.Features of imaging(1)Germ cell tumors:(1)GCTs in pineal region: 18 solid lesions and 9 cystic solid lesions;(2)GCTs in saddle region: 20 solid lesions and 8 cystic solid lesions;(3)thalamus basal ganglia GCTs: 8 solid lesions,11 cystic solid lesions,4 cases of diffuse infiltration without obvious boundaries;18 cases of Wallerian degeneration;(4)double lesions in the pineal gland and saddle area GCTs: 10 solid lesions,cysts 4 cases of solid lesions;(5)GCTs at other locations: 5 cases of solid lesions and 2 cases of cystic solid lesions.(2)Non-germ cell tumor lesions:(1)Optic glioma: MRI plain scan shows a slightly longer T1 and a slightly longer T2 signal,DWI shows a low signal,and the enhancement is obviously uniformly strengthened along the visual path;(2)Solid craniopharyngioma:MRI plain scan showed long or slightly longer T1 and T2 signals,DWI showed low signal,and strengthened evenly after enhancement;(3)Langerhans histiocytosis: MRI plain scan showed that the pituitary T1 high signal shadow disappeared and the pituitary stem thickened,Enhanced scan shows abnormal enhancement of hypothalamus,pituitary stalk and pituitary;(4)Rosai-Dorfman disease: MRI plain scan T1 shows equal signal,T2 is equal-low signal,the lesion center shows T2 low signal,and the periphery shows T2 and other signals.Enhancement;(5)Diffuse large B-cell lymphoma: CT plain scan lesions show a slightly high-density shadow;MRI plain scan shows long T1,equal or long T2 signal shadows,and the enhancement scan is a sheet-like uniform enhancement;(6)pineal gland mother cells Tumor: MRI plain scan showed short T1,short T2 signals,lobulated,and enhanced scan showed obvious uneven enhancement with cyst wall and necrosis;(7)Pineal meningioma: MRI plain scan showed long T1 short T2 mixed signal shadow,Presented with cystic solid lesions,the enhanced scan surface was unevenly strengthened,accompanied by Wall,hemorrhage;(8)pineal gliomas: irregular mass lesions,MRI plain scan showed short T1 signal,enhancement showed uneven enhancement,PET-CT showed that the tumor was highly metabolized;(9)basal ganglia glioma : The right basal ganglia has a massive long T1 signal and a slightly longer T2 signal.The boundary is not clear,and the peripheral edema of the lesion is obvious.4.Tumor markers: Of the 99 cases of germ cell tumors,41 cases were simultaneously checked for serum human chorionic Gonadotropin(β-human chorionic gonadotropin,β-hcg)and alpha-fetoprotein(α-fetoprotein,AFP).15 cases of elevatedβ-hcg(﹥5m IU/Ml),12 cases of germ cell tumors,2 cases of choriocarcinoma,and 1case of mixed germ cell tumors.AFP increased(﹥ 10 m IU/Ml)in 6 cases,5 cases of germ cell tumors,and 1 case of mixed germ cell tumors.Elevated β-hcg(﹥5m IU/Ml)and AFP(﹥10m IU/Ml)increased simultaneously in 3 cases,2 cases of germ cell tumor,and 1 case of mixed germ cell tumor.5.Statistical analysis: by paired chi-square test,serum tumor markers are used to diagnose intracranial germ cell tumors The tumor has a certain value(P ﹤ 0.05);by Wilcoxon non-parametric qualitative and test,28 cases of intracranial germ cell tumor biopsy in the saddle area before and after the first day of operation,the electrolyte level difference,before and after the biopsy pituitary There was no statistically significant difference in hormone levels(P﹥0.05).6.Stereotactic biopsy-related complications: 1case(1%)of death(bleeding)directly related to surgery;disease a small amount(3-5ml)of bleeding at the changing target or puncture needle channel,resulting in transient neurological dysfunction,but after conservative treatment,the symptoms were relieved in 3 cases(3%);hematoma at the diseased target was larger(30ml),neurological dysfunction sexual aggravation,one case(1%)under the stereotactic drainage.Conclusion:1.IGCTs,good hair at 14 to 26 years old,the pineal gland area,thalamus,basal ganglia region men see more,and saddle area women.2.sensitivity and specificity is not high,serum tumor markers preoperatively by tumor markers in the diagnosis of need careful.3.IGCTs imaging has a certain characteristic,analyzes these characteristics,can improve the preoperative diagnostic rate.Familiar with IGCTs diseases other than,can improve the differential diagnosis.4.To the 3d visualization image planning software aided by intracranial lesion biopsy is safe and reliable,can improve the security of the operation,reduce the incidence of surgical complications... |
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