手术治疗复发性原发颅内黑色素瘤1例并文献复习

目的探讨原发性颅内黑色素瘤的临床表现、诊断及复发后的治疗。方法回顾性分析南通大学附属医院2022年4月收治的1例经病理检查证实的原发性颅内黑色素瘤复发病例，结合相关文献总结颅内黑色素瘤的临床表现、影像学特征、病理诊断及治疗方法。结果患者经首次手术全切除后病理报告为恶性黑色素瘤，术后未行放化疗等后续辅助治疗，随访7年余复发，二次术后恢复良好，随访5月余未见复发。结论原发性颅内黑色素瘤长期生存者较罕见，其影像学表现多变，术前易误诊，手术全切除是治疗关键，对于复发病例重复切除仍是延长生存期的方案；放化疗效果不确切，手术结合立体定性放射治疗、靶向治疗、免疫治疗等综合方案似乎是原发性颅内黑色素瘤的最佳方案。

Objective To investigate the clinical manifestations, diagnosis and treatment for recurrent primary intracranial melanoma. Methods A case of recurrent primary intracranial melanoma which confirmed by pathological examination admitted to Nantong University Affiliated Hospital in April 2022 was analyzed retrospectively, and the clinical manifestations, imaging features, pathological diagnosis and treatment methods of intracranial melanoma were summarized in combination with relevant literature. Results Total resection was performed in the first operation, and the pathological report was malignant melanoma. No radiotherapy and chemotherapy were performed after the operation. The follow-up period was more than 7 years, and there was no recurrence for 5 months after the second operation. Conclusions Long-term survival of primary intracranial melanoma is rare, and its imaging manifestations are variable, and easy to misdiagnose before surgery. Total surgical resection is the key, and aggressively repeated surgical resection remains beneficial for recurrent cases. The effect of radiotherapy and chemotherapy are uncertain. Indeed, surgery combined with stereotactic radiosurgery(SRS), targeted therapy, immunotherapy seem to be the best solution for primary intracranial melanoma.