后颅凹肿瘤术后发热的原因及治疗

目的:总结并分析后颅凹肿瘤术后发热的治疗经验。方法:收集并分析西北医院2001年9月至2010年7月后颅凹肿瘤开颅术后发热23例病例的临床资料。结果:20例患者预后良好,痊愈出院。2例死亡,1例放弃治疗出院。结论:后颅凹肿瘤术后发热是常见并发症,处理棘手,根据不同情况采取针对性治疗可取得满意效果。     

腮腺肿瘤术后复发原因及再治疗探讨

腮腺肿瘤常为多中心性 ,具潜在恶性或恶性的生物学特性 ,术后局部复发率高[1 ] 。我院 1988年 1月至 1997年 12月共收治复发性腮腺肿瘤 47例 ,现报告分析如下。1　临床资料47例腮腺肿瘤患者中男性 2 4例 ,女性 2 3例 ,年龄 15～ 71岁 ,中位年龄 41.9岁。混合瘤恶变 11例 ,混合瘤 7例 ,黏液表皮样癌 7例 ,腺样囊性癌 6例 ,腺泡细胞癌 4例 ,乳头状腺癌 4例 ,恶性混合瘤 3例 ,鳞癌 2例 ,淋巴上皮病恶变 1例 ,恶性肿瘤分类不详 2例。 47例中 4例为我院首治后复发者 ;43例为外院手术后复发者 ,行 1次手术者 2 8例 ,行 2次手术者 14例 ,行 4次手术…     

扩大前颅窝底入路切除颅鼻眶沟通性肿瘤的术后护理

颅鼻眶沟通性肿瘤在临床上并不多见。 1996年 1月～ 1998年 1月 ,我科收治颅鼻眶沟通性肿瘤 5例 ,采用经扩大前颅窝底入路切除肿瘤 ,经过术后的治疗和护理 ,取得了良好效果 ,现将术后护理体会总结如下。1　临床资料本组 5例 ,男 3例 ,女 2例。年龄 14～ 4 6岁 ,平均年龄 3 8 6岁。全部病人行ＣＴ检查 ,3例行ＭＲＩ检查 ,诊断明确 ,住院天数 2 2～ 4 4天。 5例术后恢复好 ,全部痊愈出院。2　术后护理体会2 1　体位护理　患者全麻术后回到病室立即取去枕平卧头偏向健侧 ,防呕吐物误吸入呼吸道。待全麻清醒后 6小时 ,血压平稳后可抬高床头 15…     

原发性及术后复发气管肿瘤的外科治疗

气管肿瘤在临床上较为少见。我院自 1973年 5月至 2 0 0 2年 5月 ,共手术治疗原发性气管肿瘤 2 8例 ,其中 5例在手术切除原发性气管肿瘤后复发 ,又行第二次手术治疗。共计手术治疗气管肿瘤 33例次 ,疗效满意 ,现报告如下。1　临床资料1.1　一般资料　按手术治疗 33例次统计 :男性 14例 ,女性 19例 ;年龄 10～ 70岁 ,其中 30岁以下者 8例 ,30～ 5 0岁者 10例 ,5 0岁以上者 15例。临床表现 :咳嗽 30例 ,呼吸不畅 2 1例 ,血痰 18例。1.2　术式　按手术治疗 33例次统计 :气管袖式切除术 2 3例 ,气管肿瘤局部切除术 5例 ,气管隆凸切除重建术 3例…     

后颅凹占位性病变CT影像学探讨

收集１１７例经手术和病理证实的后颅凹占位病变病例，其中肿瘤１１４例，囊肿３例。髓母细胞瘤、星形细胞瘤及室管膜瘤多发生于青少年。小脑桥脑角好发听神经瘤、脑膜瘤、胆脂瘤，往往有四脑室侧移和后移。小脑蚓部好发髓母细胞瘤，占８２．４％，可引起四脑室前移。四脑室好发室管膜瘤，占８０％，引起四脑室扩大。小脑半球好发血管母细胞瘤、星形细胞瘤及多胶母细胞瘤、转移瘤，往往引起四脑室侧移及前移。后颅凹各种占位性病变都有ＣＴ影像学特征。可依据症状，与四脑室之间的关系，多可准确定位及定性诊断，本文定位诊断符合率为８９．７％。定位诊断准确率提高，可进一步提高定性诊断准确率。     

颅咽管瘤术后水电解质紊乱的临床特点及预后

目的探讨成人颅咽管瘤术后水电解质紊乱的临床特点、治疗以及预后。方法根据术后血钠的变化情况,对57例成人颅咽管瘤术后水电解质紊乱的临床特点和治疗进行了分析。结果除20例(35.1%)患者术后水电解质正常外,37例(64.9%)患者在术后出现了不同程度和不同类型的水电解质紊乱。其中低渗性脱水(血清钠<135 mmol/L)17例(45.9%),高渗性脱水(血清钠>150 mmol/L)7例(18.9%),等渗性脱水3例(8.1%),典型的"三期"变化6例(16.2%),高钠-低钠交替出现4例(10.8%)。结论颅咽管瘤术后水电解质异常纠正是颅咽管瘤治疗和患者恢复过程中非常重要的方面,需要及时监测其变化并给予针对性的治疗。     

颅眶及球后眶内肿瘤手术治疗：附16例临床分析

背景和目的：颅眶区解剖复杂，有许多孔隙、开口与颅内、眶内相通。由于肿瘤邻近重要的颅神经和血管，手术切除和重建颅底往往困难。本文探讨经颅入路切除颅眶沟通性肿瘤和球后眶内肿瘤的手术方法。方法：回顾性分析16例经颅入路手术切除的颅眶沟通性肿瘤和球后眶内肿瘤的临床资料，分别采用经额经眶上缘入路和经眶上一翼点入路进行。结果：全切除肿瘤14例，次全切除2例。手术后患眼失明1例，动眼神经麻痹2例，无手术死亡，手术效果满意。结论：经颅入路切除颅眶沟通性肿瘤和球后眶内肿瘤时，根据肿瘤所在眶内的位置选择恰当的手术入路是手术成功的前提，合理的手术方式和熟练的手术技巧是提高全切率、减少并发症的关键。     

原发性腹膜后肿瘤术后复发的原因分析

目的：分析原发性腹膜后肿瘤（ＰＲＴ）术后复发的影响因素以减少复发,提高手术效果。方法：回顾分析１９９０年６月～２００７年６月间收治的１３１例原发性腹膜后肿瘤手术患者,通过随访了解术后复发情况并进一步分析其与临床特征和病理类型之间的关系。结果：获随访的１２５例ＰＲＴ患者术后１、３、５年复发率分别为２０.００％（２５／１２５）、３２.６５％（３２／９８）、４３.８４％（３２／７３）;单因素分析显示手术方式（χ^２ ＝６０.０４６,Ｐ＝０.０００）、肿瘤体积（χ^２ ＝５３.３６２,Ｐ＝０.０００）、病理类型（χ^２ ＝１６.９６５,Ｐ＝０.０００）对ＰＲＴ术后复发均有影响（Ｐ＜０.０５）。多因素Ｃｏｘ回归分析表明手术方式（χ^２ ＝３５.０８０,Ｐ＝０.０００）、病理类型（χ^２ ＝１１.３７３,Ｐ＝０.００１）、肿瘤体积（χ^２＝６.８１５,Ｐ＝０.００９）显著影响术后复发。结论：手术方式、肿瘤体积、病理类型与ＰＲＴ患者的术后复发相关,其中手术方式是预测ＰＲＴ患者术后复发最显著的因素。     

胃癌术后患者肿瘤浸润性淋巴细胞治疗的临床观察

肿瘤浸润性淋巴细胞（Tumour－infiltratinglymphocytes，TIL）是一种抗肿瘤活性较强和靶细胞特异性的免疫活性细胞。但TIL较好疗效见于黑色素瘤等少数肿瘤，关于消化道实体瘤TIL治疗的临床研究较少[1]。本文分析了经重组白细胞介素2（rIL2）激活的胃癌TIL对自体和异体胃癌细胞杀伤活性，TIL疗法对患者细胞表型的影响和临床疗效，以探讨TIL对胃癌的抗肿瘤的机制和作用。1材料与方法1．1细胞培养22例胃癌标本为胃癌手术切除时获得，术前未进行治疗，病理诊断为胃腺癌。TIL及胃癌细胞制备及培养见文献[2]。1．2细胞表型分析和TIL杀…     

The microscopic surgical treatment for tumor of posterior cranial fossa in children

OBJECTIVE To analyze and discuss about the clinical characteristics, pathological types, surgical modalities and techniques, and postoperative complications in children with tumor of posterior cranial fossa.
METHODS Retrospective study was conducted on 102 cases of pediatric tumor of posterior cranial fossa, admitted and treated in our hospital during the period of January 1996 to January 2007. All patients underwent microscopic surgical treatment. Fiftyeight were male and 44 cases were female. The age ranged from 9 months to 14 years old, with an average of 6.1 ± 0.5 of age. Cranial CT or MRI examination was conducted before and after the surgery on all patients. RESULTS The primary manifestations for this group of patients were increased intracranial pressure and/or ataxia. Postoperative pathological diagnoses showed： 46 cases of medulloblastoma, 43 cases of astrocytoma, 11 cases of ependymoma （including 1 case of degenerative ependymoma）, 1 case of dermoid cyst, and 1 case of teratoma. In this group of the patients, radical surgery was used in 68 cases and subtotal surgical removal used in 31 cases, while surgical removal of large section was performed on 3 cases. There were no deaths from surgery reported. Ninety-one cases showed significant symptomatic improvement when compared with preoperative conditions, while 11 cases showed either no improvement or more severely affected afterward. For 6 cases, postoperative ventriculoperitoneal shunt was performed within 7 days to 2 months after the surgery. Sixty-three patients gained follow-up for 3 to 60 months in duration. Thirty-nine patients regained normal life and were able to learn well, while there were 7 patients who could not live normally on their own. During the follow-up period, there were 17 cases of recurrence and 7 cases of death. In 23 cases of medulloblastoma in children with age of 3 years old or above, 2 cases who underwent surgical removal of intracranial ependymoma received small dosage of postoperative X-ray radiotherapy on the the brain and spinal cord. Nine cases of medulloblastoma in children under age of 3 and 17 cases of astrocytoma diagnosed after the surgery received chemotherapy of Carmustine.
CONCLUSION Medulloblastomas and astrocytomas were the most common types of pediatric tumor of posterior cranial fossa, right followed by ependymoma, and dermoid cysts and teratomas were rare. Early correct diagnosis, proper selection of appropriate surgical modality and the surgical margin, proper treatment of postoperative complications, and the selecting right radiotherapy or chemotherapy were the key factors in influencing the prognostic outcome of children with tumor of posterior cranial fossa.     

No-glucose strategy influences posterior cranial fossa tumors' postoperative course: introducing the Glycemic Stress Index

In a selected patient population, we evaluated the glycemic response to different infusional policies in the management of posterior cranial fossa tumor (PFT) removal. We analyzed the perioperative course, prospectically collected, of 137 children undergoing 150 surgical procedures. Patients were divided in two groups according to different intraoperative fluids (group A, 2.5% glucose; group B, crystalloids). In group B glycemia remained below 125 mg dl⁻¹, while group A showed persistently supranormal glycemic plasma values, reaching statistical significance at the end of surgery (P < 0.018). As no perioperative mortality occurred and no differences were found between groups regarding PICU respiratory or infectious complications, PICU length of stay (LOS) was assumed as the main outcome indicator. LOS was not influenced by group A or B inclusion, while a new indicator, namely the Glycemic Stress Index (GSI), representing both glycemic intraoperative change and procedure length, showed significantly different results in the study groups (P = 0.004). Our clinical experience suggests that both intraoperative glucose-free solutions are safe, and GSI can be a useful tool to identify prolonged PICU stay patients.     

Primary pleomorphic adenoma in posterior cranial fossa

A 35-year-old woman had an intradural tumor in the posterior fossa adjacent to the posterior wall of the left pyramidal bone, which was totally removed and histologically diagnosed as a pleomorphic adenoma. Follow-up examination for 2 years showed no recurrence of the tumor. There was no primary lesion in any other gland of the body, and therefore there is no alternative but to conclude a “migration” of some gland cells. The pathogenesis of this tumor remains unclassified.     

后颅窝脑肿瘤的多模态磁共振成像诊断研究

目的:探讨多模态磁共振成像在后颅窝脑肿瘤中的诊断价值。方法:回顾性分析经病理证实的18例后颅窝脑肿瘤患者的MR平扫、扩散加权成像（DWI）、动态增强影像资料。结果:18例患者共有22个病灶,3例为多发病灶。所有病灶在T1WI呈低或稍低信号;T2WI上16个病灶呈稍高信号,3个呈等信号,3个呈混杂稍高信号;DWI上3例扩散受限呈高信号,12例扩散稍受限呈稍高信号,3例扩散不受限呈等信号。表观扩散系数（ADC）图上测得肿瘤实质与对照侧平均ADC值分别为(0.595±0.089)×10-3 mm2/s和(0.695±0.051)×10-3 mm2/s,两者差异有统计学意义(P=0.03),rADC为0.875±0.119。结论:多模态磁共振成像有助于后颅窝脑肿瘤的明确诊断。     

Pre and post-surgical dysphagia outcome associated with posterior fossa tumour in children

Background Swallowing impairment (dysphagia) has been reported as a possible sequela following surgical removal of posterior fossa tumours (PFT). Dysphagia may result in aspiration of food/fluid leading to respiratory tract infection, placing the patient at considerable health risk. No prospective studies have investigated dysphagia pre and post-surgical removal of PFT. The present study aimed to document the presence, severity and characteristics of dysphagia pre and post-surgical resection of PFT, and to determine whether children were managing a normal oral diet (i.e. a measure of functional swallowing ability) at two months post-surgery. Methods Dysphagia was assessed using a clinical bedside evaluation in 11 participants (8 M; aged 3 years 6 months to 13 years 5 months) pre (within 3–5 days) and post-surgery (within 1–2 weeks). Return to normal oral feeding was documented at two months post-surgery via a parent telephone interview. Results and conclusion No participant had dysphagia pre-surgically. Seventy three percent (8/11) had dysphagia at 1–2 weeks post-surgery, primarily characterized by impaired lip closure (8/8), poor mastication (8/8), and inefficient oral transit (8/8). Whilst dysphagia severity was largely mild (6/8) in presentation, data suggest that assessment and monitoring of this disorder may be required in the acute phase post-surgery. Overall however, prognosis appeared positive, with 75% (6/8) of participants managing a full oral diet at 2 months post-surgery.     

Physical functioning in pediatric survivors of childhood posterior fossa brain tumors

Background

Survival rates for children diagnosed with posterior fossa brain tumors (PFBTs) have improved significantly over the past several decades, and long-term functioning assessments have become priorities. These evaluations have occurred frequently in adults but only rarely in children. This study describes a cross-sectional assessment of physical functioning in pediatric survivors of PFBTs using the Bruininks-Osteretsky Test of Motor Performance, Second Edition (BOT-2).

Methods

Primary analyses compared BOT-2 scores to normative data using 1-sample t tests for each gross motor subscale (Bilateral Coordination, Balance, Running Speed/Agility, Strength) and motor-area composite (Body Coordination and Strength and Agility). Second, the cohort was stratified by diagnostic or treatment variables. Group differences and groups vs norms were evaluated using independent 2-sample and 1-sample t tests, respectively. Primary analyses compared BOT-2 scores with normative data using 1-sample t tests for each gross motor subscale (Bilateral Coordinationcoordination, Balance, Running Speed/Agility, Strength) and motor-area composite (Body Coordination and Strength and Agility). Second, the cohort was stratified by diagnostic or treatment variables. Group differences and groups vs norms were evaluated using independent 2-sample and 1-sample t tests, respectively.

Results

Mean age of 30 participants was 11.4 years (range, 4.9y–18.2y), and mean time from diagnosis was 6.1 years (range, 1.1y–16.7y). Cerebellar astrocytoma (43.3%) and medulloblastoma (40%) were the most common diagnoses. As a group, significantly decreased functioning, compared with norms, was observed in Balance (P < .001) and Running Speed/Agility (P = .005). Specifically in Balance, 21 (70%) participants performed below or well-below average. Participants with a non-astrocytoma performed significantly lower than norms in all areas, independent of age at diagnosis. Survivors with tumors infiltrating the vermis demonstrated significantly lower Body Coordination than norms (P < .001).

Conclusions

Pediatric survivors of PFBTs demonstrated decreased physical functioning, most notably in Balance. These data underscore the need for further research and implementation of physical activity programs aimed specifically at approaches to minimize physical limitations.     

Clinicoradiological features of rosette-forming glioneuronal tumor (RGNT) of the fourth ventricle: report of four cases and literature review

Background Rosette-forming glioneuronal tumor (RGNT) of the fourth ventricle is a recently characterized rare tumor entity. Despite benign histological features and a reported favorable postoperative course, there is still limited clinical experience with this tumor. Methods Retrospective analysis of the clinical, radiological, and surgical data in four patients with RGNT was performed. Mean age at diagnosis was 35 years, and the median follow-up was 19 (range 2–30) months. The results were compared with the literature. Results Patient 1 presented on an emergency basis due to intratumoral hemorrhage and tumor enlargement followed by life-threatening obstructive hydrocephalus. Patient 2 suffered from headaches and left-sided hemiparesthesia 6 months prior to surgery. Patient 3 developed headaches with nausea and vomiting, followed by left-sided tinnitus 1 year prior to surgery. In patient 4, RGNT was detected incidentally. No differentiating radiological characteristics were seen except for the presence of minute satellite lesions in two patients. Histopathological findings were distinct and showed their typical biphasic neurocytic and glial architecture. No progression/recurrence was seen in the postoperative course. Conclusions The spectrum of presenting symptoms of RGNT is wide, nonspecific, and typically depends on tumor size and extent. This tumor entity should be considered in the differential diagnosis of posterior fossa masses in order to avoid undue surgical aggressiveness.     

Solitary fibrous tumor of the infratemporal fossa: A case report

First described as a pleural neoplasm, the solitary fibrous tumor (fibrous mesothelioma) has been reported in a number of extrapulmonary sites, including the Head-Neck region. In the Head-Neck region, it has been described in the sinonasal tract, epiglottis, parapharyngeal, retropharyngeal spaces, parotid and infratemporal fossa. We present the second case of solitary fibrous tumor of infratemporal fossa described in world literature. A complete excision was achieved by transmaxillary approach.     

Transient mutism following posterior fossa surgery in children

We report 3 patients, ages 5, 9 and 13 years, with mutism following posterior fossa surgery (PFS). All presented with headache of 10–180 days duration, excellent premorbid learning performance and paucity of neurologic signs. Radiographic studies demonstrated large posterior fossa tumor occupying the fourth ventricle, and hydrocephalus, leading to gross total resection of the tumor. Within 24–48 hr, all patients were mute. None had problems with swallowing and coughing. AH were able to nod “yes or no,” follow commands, point to body parts, and make their wants known by gestures. Jaw, gag, snout and palmomental reflexes were normal. CT scan and MRI Brain showed no cerebral hemispheric lesions. All children regained speech although dysarthric, within 5–12 weeks. Twenty-two previously reported cases are similar to ours. We conclude that this post-surgical mutism syndrome is unique and must be differentiated from aphemia, Broca's aphasia, hysterical mutism and elective mutism. The cerebellum, in a way not yet understood, does play a role in speech production. © Wiley-Liss, Inc.