显微外科手术治疗第四脑室肿瘤42例

目的探讨显微外科手术治疗第四脑室肿瘤患儿的疗效。方法第四脑室肿瘤患儿42例,均在显微镜下采用后颅窝枕下正中入路切除肿瘤。肿瘤全切除28例,次全切除14例。结果成活40例,死亡2例。术后缄默症6例,脑积水15例,11例行侧脑室-腹腔分流术。随访30例,生活、学习良好;2例室管膜瘤术后1年肿瘤原位复发,行γ刀治疗;4例术后脑积水放弃治疗,自动出院后0.5年死亡。结论及时诊断、适当的手术方法、精准的显微外科手术、积极处理术后脑积水是提高第四脑室肿瘤疗效的关键。     

儿童第三脑室肿瘤显微手术治疗临床分析

目的 探讨显微手术切除儿童第三脑室肿瘤的手术方法 与术后管理.方法 回顾性分析2005年6月至2008年6月全组17例儿童第三脑室肿瘤患儿的临床资料,其中男10例,女7例.年龄1～14岁,平均8.3岁.病程1～33个月,平均9个月,经术前评估,选择经胼胝体-穹窿间人路切除肿瘤12例、经纵裂-经终板入路显微镜下手术切除肿瘤5例.术后病理证实颅咽管瘤9例,畸胎瘤4例,生殖细胞瘤3例,星形细胞瘤1例.结果 17例第三脑室肿瘤患儿,肿瘤全切除8例(47.1%),近全切除7例(41.2%),大部切除2例(11.7%),无死亡.术后11例出现下丘脑损害并发症.结论 正确的术前评估、选择合适的手术入路、重视术后管理是手术治疗儿童第三脑室肿瘤获得良好效果的重要环节.经胼胝体-穹窿间入路术野暴露清楚,较易全切肿瘤,术后并发症少,是切除第三脑室肿瘤值得选择的手术入路.     

儿童第三脑室肿瘤显微手术治疗临床分析

目的 探讨显微手术切除儿童第三脑室肿瘤的手术方法 与术后管理.方法 回顾性分析2005年6月至2008年6月全组17例儿童第三脑室肿瘤患儿的临床资料,其中男10例,女7例.年龄1～14岁,平均8.3岁.病程1～33个月,平均9个月,经术前评估,选择经胼胝体-穹窿间人路切除肿瘤12例、经纵裂-经终板入路显微镜下手术切除肿瘤5例.术后病理证实颅咽管瘤9例,畸胎瘤4例,生殖细胞瘤3例,星形细胞瘤1例.结果 17例第三脑室肿瘤患儿,肿瘤全切除8例(47.1%),近全切除7例(41.2%),大部切除2例(11.7%),无死亡.术后11例出现下丘脑损害并发症.结论 正确的术前评估、选择合适的手术入路、重视术后管理是手术治疗儿童第三脑室肿瘤获得良好效果的重要环节.经胼胝体-穹窿间入路术野暴露清楚,较易全切肿瘤,术后并发症少,是切除第三脑室肿瘤值得选择的手术入路.     

儿童第三脑室肿瘤显微手术治疗临床分析

目的 探讨显微手术切除儿童第三脑室肿瘤的手术方法 与术后管理.方法 回顾性分析2005年6月至2008年6月全组17例儿童第三脑室肿瘤患儿的临床资料,其中男10例,女7例.年龄1～14岁,平均8.3岁.病程1～33个月,平均9个月,经术前评估,选择经胼胝体-穹窿间人路切除肿瘤12例、经纵裂-经终板入路显微镜下手术切除肿瘤5例.术后病理证实颅咽管瘤9例,畸胎瘤4例,生殖细胞瘤3例,星形细胞瘤1例.结果 17例第三脑室肿瘤患儿,肿瘤全切除8例(47.1%),近全切除7例(41.2%),大部切除2例(11.7%),无死亡.术后11例出现下丘脑损害并发症.结论 正确的术前评估、选择合适的手术入路、重视术后管理是手术治疗儿童第三脑室肿瘤获得良好效果的重要环节.经胼胝体-穹窿间入路术野暴露清楚,较易全切肿瘤,术后并发症少,是切除第三脑室肿瘤值得选择的手术入路.     

经小脑延髓裂入路显微手术治疗儿童第四脑室肿瘤

目的 探讨经小脑延髓裂(CMF)人路显微手术治疗儿童第四脑室肿瘤的方法,提高手术治疗效果.方法 对17例2～14岁原发第四脑室肿瘤患儿,采用枕下正中切口、横窦下颅骨开窗骨瓣成形及经小脑延髓裂入路显微切除肿瘤,其中广泛型CMF切开12例,外侧壁型切开3例,外侧隐窝切开2例;硬脑膜严密缝合或修补,骨瓣复位并固定.结果 肿瘤全切除15例,次全切除2例,病理结果髓母细胞瘤9例,室管膜瘤5例,星形细胞瘤3例,无围手术期死亡发生.术后15例患儿症状体征均明显改善或消失,无新发共济失调、震颤、肌张力降低及脑积水、小脑缄默综合征等并发症.复发2例,均为髓母细胞瘤,2年后死亡1例.结论 经小脑延髓裂人路能较好地显露儿童第四脑室肿瘤,可减少因切开小脑蚓部和向侧方牵拉损伤小脑所导致的并发症发生.     

儿童脊髓内肿瘤的显微外科治疗

目的总结儿童髓内肿瘤的病理特点、显微手术和治疗效果，并进行探讨。方法81例儿童脊髓内肿瘤均经手术切除和病理证实，对手术治疗的效果进行回顾性分析。结果儿童髓内肿瘤以星形细胞瘤24例（29．6％）、室管膜瘤13例（16．0％）和表皮样囊肿11例（13．6％）为多见，不同的病理类型的肿瘤，切除率不同。放疗用于高度恶性的肿瘤。椎板复位术可以有效地减少脊柱畸形的发生率。结论大多数的髓内肿瘤组织学上为低级别星形细胞瘤（Ⅰ～Ⅱ级）、室管膜瘤和胚胎残余组织肿瘤，积极手术切除能够获得满意的疗效。     

显微技术切除儿童侧脑室肿瘤

目的：探讨儿童侧脑室肿瘤显微外科手术的治疗方式和临床效果。方法：回顾性总结51例儿童侧脑室肿瘤的临床表现、诊断方式、手术入路的选择与疗效。根据肿瘤的部位和大小分别采用经额中回入路、经顶枕叶或顶上小叶入路、经胼胝体入路，对儿童侧脑室肿瘤进行显微外科手术治疗。结果：51例儿童侧脑室肿瘤中，位于侧脑室三角区27例，侧脑室前角12例，侧脑室体部9例，室间孔区3例，左侧脑室27例，右侧脑室24例。肿瘤直径2～6．5cm。所有肿瘤均经手术和病理证实，肿瘤全切除43例，近全切除6例，大部切除1例，部分切除加外减压1例。31例获得随访，28例生活基本上能自理或参加学习。结论对儿童侧脑室肿瘤选择适当的手术入路进行显微外科手术能有效地降低手术创伤，提高全切除率，减少致残率和病死率，对于无法手术切除的肿瘤可以采用术后放疗和立体定向放射外科治疗，可减少本病复发。     

小脑延髓裂入路手术切除儿童第四脑室肿瘤

目的探讨经小脑延髓裂入路（ transcerebeliomedullochoroidal fissure, TCMCF）手术切除儿童第四脑室肿瘤的临床疗效。方法2004年11月至2010年11月,河南省开封市陇海（脑科）医院神经外科采用枕下正中切口,经小脑延髓裂入路,应用显微外科技术对20例第四脑室肿瘤患儿进行手术治疗。结果20例中,手术完全切除17例,次全切除3例;术后病理检查提示髓母细胞瘤12例,室管膜瘤6例,脉络丛乳头状瘤1例,星形细胞瘤1例。结论经小脑延髓裂入路,不需切开小脑蚓部,可避免损伤正常小脑组织,暴露范围广,有助于彻底切除第四脑室肿瘤,提高手术疗效。     

儿童囊性毛细胞型星形细胞瘤的治疗

目的 总结儿童囊性毛细胞型星形细胞瘤的临床特点和治疗经验。方法 回顾性分析过去5年间我科收治的20例儿童囊性毛细胞型星形细胞瘤的临床资料。本组20例，占同期住院胶质瘤的6．0％，发病年龄平均为9岁。病变在小脑者14例，下视丘/视路2例，三脑室内2例，大脑半球内2例。20例患儿均接受显微手术治疗。肿瘤位于小脑幕者采用下正中入路；肿瘤位于下视丘／视路者采用翼点入路；三脑室内肿瘤选择胼胝体-透明隔入路，颞叶肿瘤均采用额颞瓣开颅。肿瘤全切除18例。2例术后有残余者接受放射治疗。照射剂量30～40Gy。无手术死亡。结果 术后1周内行影像学检查以证实切除程度。20例在术后24h行头颅CT检查，12例在术后4～6周行MRI检查做为以后MRI检查的对比基础。18例随访半年以上无复发。结论 儿童囊性毛细胞型星形细胞瘤为良性肿瘤，预后较好，显微手术切除和恰当的放疗是治疗的关键。     

小儿囊性颅内肿瘤同位素内放射治疗:附18例报告

小儿脑肿瘤是常见的危及儿童健康的肿瘤,临床上治疗以手术切除为主,但对于部分以囊性为主、位于垂体-下丘脑要害部位肿瘤手术难以达到全切,术后易导致垂体功能低下和内分泌紊乱[1,2],以及对于脑肿瘤术后复发难以承受第2次大手术者,以往常采用放疗、化疗,总的疗效不甚满意更带来严图15岁男孩子,右额叶室管膜瘤3级图2术后9月,肿瘤切除部位囊性复发图3内放疗后囊肿消失重并发症,针对上述患儿的治疗,我科于2000年1月至2005年4月采用同位素胶体32P注入瘤腔行微创性的姑息放射治疗,取得满意近期疗效,现报告如下。临床资料一、一般资料18例患儿,年…     

儿童髓母细胞瘤显微手术治疗

目的：探讨儿童髓母细胞瘤的显微手术方法及相关问题。方法：回顾性分析经四脑室顶部切开联合四脑室正中孔入路显微手术切除并经病理证实的小儿髓母细胞瘤27例。结果：手术全切除22例(81.5%)、次全切5例(18.5%)。术后26例颅高压症状消失，临床体征改善，1例恶化，无与手术有关的严重并发症和手术死亡。肿瘤位于小脑蚓部6例，四脑室内9例，小脑蚓部和四脑室内者11例，小脑半球1例。肿瘤供血来源于双侧小脑后下动脉分支19例。术中打通导水管26例，1例术中同时行枕大池分流。术后25例病人随访5个月至3年4个月，并接受放疗。其中23例未见复发或转移，1例转移至骨髓，3例原位复发。结论：正确认识小儿髓母细胞瘤的病理解剖结构及其周围组织结构有利于肿瘤切除，采用显微手术全切除肿瘤组织, 妥善保护好小脑后下动脉及分支，避免伤及脑干和四脑室底的结构，术中解除导水管梗阻，是降低复发和转移率、延长生存期的关键。     

Central nervous system tumors in patients under three years of age: treatment results of a single institute

Eighty-six patients under 3 years of age with central nervous system tumors were retrospectively analyzed between 1972 and 2003. Surgical resection was done in all patients except for those with optic glioma, pons glioma and pineal tumor. Three different chemotherapy regimens were used in different time periods. In 48 patients, the tumor was located in the posterior fossa, and 29 patients had a supratentorial tumor. We had 32 (37.2%) patients with embryonic tumors (21 medulloblastoma, 4 ependymoblastoma, 5 with atypical teratoid rhabdoid and 2 with supratentorial primitive neuroectodermal tumors), 21 (24.4%) with ependymoma, 14 (16.3%) with optic glioma, 10 (11.6%) with astrocytoma, 3 (3.5%) with pons glioma and 6 (7.0%) with others. Overall (OS) and event-free survival rates were 49.5 and 40.9%. OS rates according to the tumor localizations were 40.9 and 68.1% in the posterior fossa and supratentorial localizations, respectively (p=0.001). OS rates were 33.7, 41.3 and 88.8% for the medulloblastoma+primitive neuroectodermal tumor groups, ependymoma and astrocytoma, respectively (p=0.0001). Most of the patients had primitive embryonic tumors (37.2%). The best prognostic factors were tumor localization and histology.     

Management of hydrocephalus in children with posterior fossa tumors: role of tumor surgery

OBJECTIVE: The majority of children with posterior fossa tumors have hydrocephalus (HC) at the time of presentation. There is no consensus regarding the management of HC in these children. Here, we report the rate of cure of HC with tumor surgery alone. PATIENTS AND METHODS: This is a retrospective study of 87 children with posterior fossa tumors in which 35 patients had medulloblastoma, 38 had astrocytoma and 14 had ependymoma. The mean age at presentation was 7.3 years (range: 0.2-19.7 years). All patients underwent tumor resection and were followed with close clinical and image surveillance to detect persistent HC. HC was treated with endoscopic third ventriculostomy (ETV) or shunt. We have focused on patients who needed permanent cerebrospinal fluid diversion (ETV or shunt) within 30 days of tumor resection. HC presenting after this time period is, in the majority of cases, due to tumor recurrence or progression. In this series, 24/87 (28%) patients had a suboccipital craniectomy and 63/87 (72%) had a craniotomy. RESULTS: At the time of presentation, 69/87 (79%) patients had symptomatic HC. In 41/69 (59%) patients presenting with HC, the HC was cured by tumor resection alone. The HC cure rate for patients with astrocytoma was 83%, whereas it was 47% for patients with medulloblastoma and 54% for patients with ependymoma. The cure rate was equal in the craniectomy and craniotomy groups. CONCLUSIONS: An 87% cure rate of HC by tumor resection alone in children with posterior fossa astrocytoma warrants no change in treatment strategy. However, the low cure rate of HC by tumor resection alone in patients with medulloblastoma and ependymoma raises the issue of whether these patients would benefit from preresection ETV.     

Posterior fossa ependymoma with intense but transient disseminated enhancement but not metastasis

We report a pediatric patient with a posterior fossa ependymoma in whom the second of two magnetic resonance imaging (MRI) scans obtained preoperatively within a 10-day span showed intense but transient disseminated enhancement. However, following posterior fossa craniotomy for near total tumor resection, neither three MRI exams nor two craniospinal fluid samplings revealed evidence of disseminated disease. Concerned that the one MRI with disseminated enhancement indicated an elevated risk of leptomeningeal metastasis, we initiated craniospinal irradiation. However, we terminated this treatment after realizing that the bulk of the clinical evidence refuted the diagnosis of metastatic disease.     

Clear cell ependymoma of the temporal lobe in a child: a case report

A 12-year-old boy with a left temporal tumor diagnosed as clear cell ependymoma (CCE) was reported. CCE is an uncommon central variant of ependymomas with a predilection for the supratentorial region in children. Brain tumors with a honeycomb pattern with clear cells having round nuclei and perinuclear halos could pose a problem in the differential diagnosis with the other tumors with clear cells. There were 41 reported cases of CCE in the literature. In 61% of these cases, tumors were located in the supratentorial region, and in the others in the posterior fossa and spinal cord. However, there was none located in the temporal lobe except in the case presented here.     

Primary cerebellar histiocytic sarcoma in a 17-month-old girl

The authors report on a case of histiocytic sarcoma (HS) in a pediatric patient presenting with a solitary tumor in the cerebellum, with the aim of providing insight into primary HS in the CNS, which is especially rare. A 17-month-old Japanese girl presented with a 2-week history of progressive gait disturbance. Brain MRI revealed a 4.7 × 4.3 × 4.3-cm well-demarcated solitary mass in the right hemisphere of the cerebellum, initially suggestive of medulloblastoma, ependymoma, or anaplastic astrocytoma. On intraoperative inspection the cerebellar tumor showed intensive dural attachment and was subtotally removed. Histological and immunohistochemical findings were consistent with HS. The patient subsequently received chemotherapy, and her preoperative neurological symptoms improved. Primary HS in the CNS usually demonstrates an aggressive clinical course and is currently considered to have a poor prognosis. The possibility of this rare tumor should be included in the differential diagnosis of localized cerebellar tumors in the pediatric age group.     

Intra-operative MRI-guided approaches to the pediatric posterior fossa tumors.

INTRODUCTION: The posterior fossa in a child poses a considerable challenge to the neurosurgeon. MRI-guided surgery allows for real time interaction between imaging and the neurosurgeon, not permitted by frameless stereotaxy, and with higher resolution than ultrasound or CT. MATERIALS AND METHODS: The University of Minnesota 1.5 T Phillips interventional MRI was used. From 1997 to 2000, nine posterior fossa intraoperative magnet cases out of eleven were pediatric. The mean age was 6.4 years and the median age 7. Seven midline craniotomies were performed, of which three were re-operations. Two were burr hole placements, one for cyst aspiration and P32 instillation, and the other for tumor biopsy. RESULTS: Two tumors were predominantly in the fourth ventricle, four in the cerebellum, two in the brainstem, and one in the prepontine cystern. Four tumors were juvenile pilocytic astrocytomas, two were anaplastic astrocytomas, and one each was ependymoma, craniopharyngioma cyst, and medulloblastoma. Four patients had complete radiologic resection. Two had maximal resections limited by vital structures. P32 instillation and tumor biopsy were done in a single pass. Follow-up ranged from 3 months to 1.4 years. The cyst that was aspirated and had P32 instillation remains absent. The two mortalities were in the patients with medulloblastoma and anaplastic astrocytoma. There were no intra-operative mortalities. The other patient with anaplastic astrocytoma progressed. The remainder had stable imaging. CONCLUSION: MRI-guided surgery results in improved resection imaging and real-time needle guidance in tumor operations. Its value could lie in low-grade lesions, where maximal resection is most beneficial.