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目的:探讨CT或MRI显示占位效应及强化不明显胶质瘤的有效诊治方法。方法:19例CT或MRI检查显示无明显占位效应,并且强化均不明显,CT平扫及增强,呈低密度,MRI T1WI呈低信号,T2WI呈稍高或高信号的局限性病变。结果:10例不排除非胶质瘤,宜先观察或保守治疗半月至1月,病灶无变化,诊断仍不明确者,手术治疗;9例拟诊胶质瘤者,均作剖颅探查。19例术中发现均为实性肿瘤。其中,14例病变肉眼几乎难与正常脑组织区别,切除时感觉质地较韧,血供差;5例病变呈鱼肉状,淡肉红色,质软,血供较差,为较典型胶质瘤。位于中央沟附近3例,该3例中2例采用立体定向开颅手术,1例采用CT定位开颅手术。后者术中肉眼确定病变困难,导致术后肢体活动障碍加重,余18例疗效满意。病理检验为星形细胞瘤Ⅰ~Ⅱ级12例,少枝胶质细胞瘤2例,星形细胞瘤Ⅲ~Ⅳ级5例。结论:对于CT或MRI显示占位效应及强化不明显脑内病变,保守治疗无效者,尤位于非功能区病变者,应积极考虑开颅手术切除。对位于功能区病灶或小病灶,应采用立体定向开颅手术,避免因寻找病变困难而导致术后神经功能废损症状加重,或造成不能获得准确病检结果的不良后果。
Objective: To explore the effective diagnosis and treatment of tumor-bearing effect and enhancement of non-obvious glioma by CT or MRI. Methods: Totally 19 patients with CT or MRI showed no significant mass effect, and the enhancement was insignificant. CT scan and enhancement showed low density, MRI T1WI showed low signal, and T2WI showed slightly higher signal or higher signal. Results: 10 cases did not rule out non-glioma, should first observe or conservative treatment of a half months to January, no change in the lesion, the diagnosis is still not clear who, surgical treatment; 9 cases of suspected glioma were skull exploration. 19 cases were found in solid tumors. Among them, 14 cases of eye lesions almost difficult to distinguish normal brain tissue, removal of the feeling of tough texture, poor blood supply; 5 cases were fish-like, pale red meat, soft, poor blood supply for more typical glioma . Three cases were located near the central gullet. Two of the three patients underwent stereotactic craniotomy and one case underwent CT craniotomy. The latter was identified intraoperatively difficult lesions, resulting in postoperative physical activity disorders worse, more than 18 cases of satisfactory results. Pathological examination of astrocytoma grade Ⅰ ~ Ⅱ 12 cases, 2 cases of gioblastoma, astrocytoma Ⅲ ~ Ⅳ grade in 5 cases. Conclusion: CT or MRI showed mass effect and intensive non-obvious brain lesions, conservative treatment ineffective, especially in non-functional area lesions should be actively considered craniotomy resection. For functional lesion or small lesions, stereotactic craniotomy should be used to avoid lesions due to difficult to cause postoperative deterioration of neurological impairment, or result in failure to obtain accurate results of the adverse consequences.