探讨大型中枢神经细胞瘤的临床治疗经验。

回顾性收集首都医科大学附属北京天坛医院神经外科自2012年4月至2019年9月由同一术者行手术治疗的35例中大型中枢神经细胞瘤患者，按照肿瘤直径将患者分为大型中枢神经细胞瘤（最大径≥5 cm）和非大型中枢神经细胞瘤（3 cm<最大径<5 cm）。对患者进行长期随访[平均（71.20±29.3）个月]，统计患者的临床特征、治疗方案以及预后的差异，并按照末次随访时的复发情况进一步将患者分为复发中枢神经细胞瘤和非复发中枢神经细胞瘤，分析中枢神经细胞瘤复发的影响因素。

35例患者中，大型中枢神经细胞瘤25例（71.4%），非大型中枢神经细胞瘤10例（28.6%）。32例患者行经额皮质造瘘开颅侧脑室肿瘤切除术，3例患者行经顶枕皮质造瘘三角区入路开颅侧脑室肿瘤切除术。术后肿瘤全切除34例（97.1%），均伴有不同程度的并发症，3例脑积水患者术后行脑室-腹腔分流手术，5例患者术后接受放射治疗，2例患者术后复发。统计结果显示，大型与非大型中枢神经细胞瘤患者的手术切除率、术后并发症（失语、癫痫、发热、严重脑积水、记忆力下降）、放射治疗及复发情况比较，差异均无统计学意义（P>0.05）。术后复发与未复发患者的肿瘤体积、手术切除率、初次术后放射治疗比较，差异均无统计学意义（P>0.05）。

经额皮质造瘘入路切除肿瘤是脑室内中、大型中枢神经细胞瘤的可靠治疗选择，手术全切肿瘤后患者能够长期高质量生活并达到临床治愈。术后放射治疗及分流手术不是影响患者预后的核心因素。

To explore the clinical treatment experience of large central neurocytoma.

A retrospective study was conducted on 35 patients with medium to large central neurocytoma treated by the same surgeon in Neurosurgery Department of Beijing Tiantan Hospital, Capital Medical University from April 2012 to September 2019. The patients were divided into large central neurocytoma (the largest diameter of tumor ≥5 cm) and non-large central neurocytoma (3 cm<the largest diameter of tumor <5 cm) based on tumor diameter. Long term follow-up was conducted on patients [with an average of (71.20±29.3) months], and differences in clinical characteristics, treatment plans, and prognosis were statistically analyzed. Patients were further divided into recurrent and non-recurrent central neurocytoma based on their recurrence at the last follow-up, and the influencing factors of central neurocytoma recurrence were analyzed.

Among the 35 patients, 25 (71.4%) had large central neurocytoma and 10 (28.6%) had non-large central neurocytoma. Thirty-two patients underwent craniotomy via frontal cortex for lateral ventricular tumor resection, and 3 patients underwent craniotomy via the triangular approach of parietal occipital cortex fistulation for lateral ventricular tumor resection. Thirty-four patients (97.1%) underwent total tumor resection after surgery, all accompanied by varying degrees of complications. 3 patients underwent ventriculoperitoneal shunt for hydrocephalus after operation, 5 patients received radiotherapy after the first surgery, and 2 patients experienced postoperative recurrence. The statistical results showed that there was no statistically significant difference in extent of resection, postoperative complications (aphasia, epilepsy, fever, severe hydrocephalus, decreased memory), radiation therapy, and recurrence between large and non large central neurocytoma patients (P>0.05). There was no statistically significant difference in tumor volume, extent of resection, and initial postoperative radiotherapy between patients with postoperative recurrence and those without recurrence (P>0.05).

Transfrontal cortex fistulation is a reliable approach for resection of tumors in the middle and large central neurocytoma in the ventricles. After total resection of tumors, patients can live a long and high-quality life and achieve clinical cure. Postoperative radiotherapy and shunt surgery are not the core factors affecting the prognosis of patients.