儿童第四脑室肿瘤所致脑积水治疗探讨

目的 探讨第四脑室肿瘤相关性脑积水的治疗.方法 总结天津市环湖医院自2008年5月至2010年5月间收治的31例第四脑室周围肿瘤患儿脑积水的处理结果.患者分为3组:A组(5例):肿瘤切除术前行脑室-腹腔分流术;B组(15例):肿瘤切除术后处理组,又分为B1组(7例),即术后仍有脑积水实施脑室分流术;B2组(8例):第三脑室底造瘘术;C组(11例),肿瘤切除术后脑积水自行缓解.患儿长期随访中出现的脑积水症状以及各方法的并发症出现情况对比;影像学以MRI脑室相关径线的改变为评价指标.结果 A组术前2 d行脑室-腹腔分流者,术后未再出现脑积水症状,1例有裂隙脑室;B1组7例脑室-腹腔分流术,1例裂隙脑室,1例分流管梗阻更换分流管;B2组8例行第三脑室底造瘘术,2例头皮缝合口漏,1例硬膜下积液.组间对比分析表明,A组和B组间,B1和B2组问并发症的发生率差异无统计学意义(P>0.05);MRI脑室各相关径线值改变差异无统计学意义(P>0.05).结论 脑室-腹腔分流或第三脑室底造瘘方法均能解决第四脑室肿瘤相关性脑积水.

Abstract：

Objective To investigate the management of hydrocephalus caused by tumors of the 4th ventricule. Method Thirty - one children with tumors of the 4th ventricule treated in Huanhu hospital in Tianjin,among which 13 patients had medulloblastoma, 13 ependymoma,3 astrocytoma and 2 choroid plexus papilloma. The patients were divided into three groups. Group A (5 cases): all the patients preoperatively accepted ventriculo - peritoneal shunting(V -Ps). Group B(15 cases): postoperative management group, which was divided into two subgroups,group B1 and group B2. V -Ps were performed in group B1(7 cases) for hydrocephalus after resection of tumor and endoscopic third ventriculostomy ( ETV) in group B2 (8 cases). The patients in group C ( 11 cases) did not develope hydrocephalus after tumor resection. Results There was no postoperative hydrocephalic sign in 5 patients treated by V - Ps 2 days before tumor resection. 15 out of 31 patients(48% ) developed hydrocephalus after resection of tumor. 7( group B1) of 15 patients were treated with V - Ps,of them one had slit ventricule and one recepted shunt tube reversion. 8 (group B2)of 15 patients underwent ETV,of them one had subdural hydroma and 2 had leakage of incisioa 11 (group C) out of 31(35% ) had no hydrocephalus. Radiological assessement was performed with 4 ventricule index( Ⅵ),including the maximal width of frontal horns,occipital horns,biparietal and 3th ventricule. There was no significant diference ( P > 0. 05 ) among the three groups in ventricule indexes and postoperative complications. Conclusions The 4th ventricule tumor - related hydrocephalus could be resolved by V - Ps or ETV. It is more rational to deal with the hydrocephalus just after the resection of tumor.     

神经内镜治疗第三脑室肿瘤合并脑积水四例报道及文献回顾

目的 探讨第三脑室肿瘤合并脑积水经神经内镜治疗的方法和手术技巧.方法 分析北京世纪坛医院神经外科收治的4例第三脑室肿瘤合并脑积水患者(前侧部肿瘤2例,底部肿瘤1例,后部肿瘤1例)的临床资料、影像学表现,结合相关文献总结手术经验与技巧.结果 4例患者中3例采用单纯神经内镜手术,1例采用神经内镜辅助显微镜下手术.术后患者临床症状明显改善,无严重并发症及死亡病例.随访3～18月,患者复查头部MRI显示肿瘤无复发,脑积水均有不同程度改善.结论 神经内镜导航下可直达肿瘤所在位置,又可减少不必要的损伤,切除肿瘤同时可解除梗阻性脑积水,重建脑脊液循环,是一种治疗第三脑室肿瘤合并脑积水安全有效的手术方法.

Abstract：

Objective To explore the treatment methods and surgical techniques of the third ventricle tumor combined with hydrocephalus under neuroendoscope. Methods The clinical data and imaging findings of 4 patients with third ventricle tumor combined with hydrocephalus, treated with surgery under neuroendoscopy, were retrospectively analyzed; and related literatures were reviewed to conclude the surgical experiences and skills. Results Three of the 4 patients were performed surgery only by neuroendoscopy, and 1 by neuroendoscopic auxiliary microscope for the tumor complete resection. The clinical symptoms improved obviously after the surgery, and no significant complications and no dead case were noted.We followed up the 4 patients for 3-18 months; MRI showed that the tumor did not relapse and the hydrocephalus got improvement. Conclusion Endoscopic navigation can help to directly reach the locations of third ventricle tumor and decrease the unnecessary damage, which enjoys its advantages in tumor resection,relieving obstructive hydrocephalus and rebuilding the cerebrospinal fluid circulation, indicating that surgery under neuroendoscope is a safe, effective and minimally invasive method.     

改良翼点入路显微切除鞍结节脑膜瘤

Objective To summarize the experience with modified transpterygoid craniotomy for microsurgical resection of tuberculum sellae meningiomas. Methods The clinical data were retrospectively analyzed in 26 patients with tuberculum sellae meningiomas admitted between January, 2001 and April, 2007 in our hospital to receive microsurgical meningioma removal using a modified transpterional approach. The basal part of the tumor was firstly coagulated and dissected to control the blood supply of the lesion. Through the cerebral cisterns in the sellar region and the interfaces between the tumor and the adjacent structures, the tumor was removed to the greatest possible extent with minimal invasiveness to the neighboring structures. Results Simpson grade Ⅰ resection was achieved in 11 patients, grade Ⅱ resection in 14 patients, and grade Ⅲ resection in 1 patient. The visual acuity and the optic field were improved in 23 patients, and remained unchanged in 1 patient after the operation. Two patients had postoperative visual acuity deterioration, which was improved after appropriate treatment. Seven patients developed diabetes insipidus after the operation, and gradually recovered after symptomatic treatments for about 10 days without fatal consequences. Follow-up for 6 months to 5 years found no recurrence of meningiomas in these patients. Conclusions The modified transpterional approach provides excellent exposure of the middle fossa, anterior cranial fossa, saddle and parasellar areas, and is effective for different types of tuberculum seilae meningiomas with increased total resection rate and reduced postoperative complications.     

中枢神经细胞瘤94例临床分析

目的 总结中枢神经细胞瘤临床特点,探讨其治疗策略.方法 回顾性分析94例中枢神经细胞瘤患者临床资料.全部行手术治疗,肿瘤全切除66例,近全切除26例,部分切除2例;分析总结中枢神经细胞瘤的临床、病理、影像特点.结果 死亡2例,随访84例,术后放疗56例,肿瘤复发4例.多数患者生存良好.结论 中枢神经细胞瘤多发于室间孔附近侧脑室系统,手术全切除是最佳治疗手段,未全切患者术后放疗可减少复发率.

Abstract：

Objective To analyze the clinical characteristics of central neurocytomas,and discuss the therapeutic strategies.Methods 94 cases of central neurocytomas were studied retrospectively.All patients underwent operation with removal of the tumor through either transcallosal or transcortical approach.Total resection was achieved in 66 patients,subtotal resection in 26 patients and partial resection in 2 patients.The clinical,radiological,histologic and immunohistochemical features of these patients were reviewed and analyzed.Methods Amongthe 94 cases of central neurocytomas,two died after surgery.Among the 84 followed- up cases,56 cases underwent postoperative radiotherapy,4 cases had recurrence.Most patients have favorable prognosis.Conclusion Central neurocytomas occur mostly in the lateral ventricle near the Monro's foramen.Total resection is the best treatment.Postoperative radiotherapy for partially removed tumors may reduce the possibility of recurrence.     

高场强术中磁共振对脑胶质瘤切除程度及手术策略的影响

目的 评价高场强术中磁共振(iMRI)对脑胶质瘤手术切除程度及手术策略的影响.方法 解放军总医院神经外科自2009年10月至2010年6月将高场强iMRI系统应用于胶质瘤切除术患者106例,术前了解术者的切除意图(全切、次全切、大部切除),术前1 d患者常规行MRI扫描,应用影像数据和软件计算术前肿瘤体积,术中常规使用神经导航手术,依据术者的需求采集影像.必要时行iMRI扫描计算术中残余肿瘤体积和肿瘤体积切除百分比,分析使用iMRI对肿瘤切除程度、手术策略的影响.结果 术前计划全切48例,次全切41例,大部切除17例.术中第一次扫描示42例(39.6%)完全切除,64例(60.4%)仍有残留,其中25例由于肿瘤与重要功能区或重要传导束紧邻而未作进一步切除,其余39例(36.8%)改进手术策略,标记出残留肿瘤后进一步手术,25例(23.6%)胶质瘤最终全切除,肿瘤体积切除百分比由(76.5±20.5)%提高到(94.2±8.7)%,差异有统计学意义(U=2.000,P=0.000);最终实际全切67例,次全切25例,大部切除14例,全切率有所提高.106例患者平均肿瘤体积切除百分比由第一次扫描时的(86.3±20.2)%提高到最终扫描时的(93.6±12.4)%,差异有统计学意义(U=4.000,p=0.000).结论 高场强iMRI的应用可显著提高脑胶质瘤的切除程度,改进手术策略.

Abstract：

Objective To evaluate the impact of high-field intraoperative magnetic resonance imaging (iMRI) on extension of resection and surgical strategy modification for glioma surgery. Methods One hundred and six patients, admitted to our hospital from October 2009 to June 2010, were performed glioma resections with the help of high-field iMRI. Questionnaires were filled and collected prospectively to record the surgeons' intention on the extent of resection (EoR) and the intra-operative estimation of EoR before every iMRI scan. The scan imagings were collected based on the request of the surgeon, and the percentage of tumor removal was calculated according to the iMRI data. The impact of iMRI on the tumor EoR and modification of surgical strategy was then evaluated. Results Preoperatively, 48 patients were intended to achieve total tumor removal, 41 sub-total tumor removal, and 17 partial removal. The first intraoperative MRI scan revealed that 42 (39.6%) patients achieved complete resection, while residual tumors were depicted in 64 (60.4%).Further tumor resections were performed in 39 patients (36.8%), but the other 25 patients could not perform further resection for their tumors were closely neighbored to the important functional region or important tracts. Finally, in the whole cohort, the percentage of tumor resection volume was increased from (76.5±20.5)% to (94.2±8.7)%, with significant differences (U=2.000, P=0.000); 67 patients got complete removal, 25 sub-total removal and 14 partial removal; The total removal rate was significantly increased from 45.3% (48/106) to 63.2% (67/106): the average percentage of tumor resection volume in the second time of scan ([93.6±12.41%) was obviously increased as compared with that in the first scan ([86.3±20.21%, U=4.000, P=0.000). Conclusion High-field iMRI may increase the extent of glioma resection, and has significant impact on the intraoperative modification of the surgical strategy.     

大型听神经瘤常见并发症及其防治

目的 探讨神经电生理监测下经枕下乙状窦后入路切除大型听神经瘤的常见并发症及其防治措施.方法 安徽医科大学附属省立医院神经外科自2006年5月至2010年4月在神经电生理监测下采用枕下乙状窦后入路手术切除大型听神经瘤116例,回顾性分析患者的临床资料和随访结果,比较肿瘤大小对患者术后近期、远期并发症发生率的影响.结果 本组肿瘤全切除107例,次全切除7例,大部切除2例;术中面神经解剖保留101例(87.07%),术后1周根据House-Brackman面神经功能分级标准对患者面神经功能进行评估显示Ⅰ、Ⅱ级89例(76.72%),Ⅲ、Ⅳ级13例(11.21%),Ⅴ、Ⅵ级14例(12.07%).患者出院后随访3～12个月,近期并发症主要为-过性声嘶、饮水呛咳(16例)和患侧单纯性疱疹(20例);远期并发症主要为听力丧失(83例)、永久性面瘫(23例);肿瘤直径>5 cm患者近期并发症中声嘶、饮水呛咳和患侧单纯性疱疹发生率较直径3～5 cm患者高,差异有统计学意义(P<0.05).结论 熟悉手术入路相关临床解剖、积累手术经验、肿瘤大小、术中神经电生理监测是减少手术并发症的关键因素.

Abstract：

Objective To discuss the common complications of large acoustic neuromas performed surgery via suboccipital retrosigmoid approach under neurophysiological monitoring, and the prevention of postsurgical complications. Methods One hundred and sixteen patients with large acoustic neuromas, admitted to our hospital from May 2006 to April 2010, were performed surgery via suboccipital retrosigmoid approach under neurophysiological monitoring; clinical data and follow-up data (3-12 months) of these patients were collected and analyzed retrospectively; the influence of tumor dimension on short- and long-term postoperative complications after the surgery were compared.Results Total tumor resection was achieved in 107 patients, subtotal resection in 7 patients, and partial resection in 2 patients. After the operation, the facial nerve was preserved anatomically in 101 patients (87.07%); and the functional valuation of facial nerve according to postoperative House-Brackman showed 89 patients (76.72%) in grade Ⅰ-Ⅱ, 13 patients (11.21%) in gradeⅢ-Ⅳ and 14 patients (12.07%) in grade Ⅴ-Ⅵ. Short-term postoperative complications included hoarse voice in 16 patients and herpes catarrhalis of injured side in 20 patients. Long-term postoperative complications included loss of hearing (n=83) and permanent facial paralysis (n=23). Patients with tumor dimension larger than 5 cm had a significantly higher incidence of short-term postoperative complications than those within 3-5 cm (P< 0.05). No patient died. Conclusion The keys to avoiding the complications are to master the clinical anatomy of the approach, accumulate surgical experiences, preoperatively study the individual imaging and clinical data, and use intraoperative nerve monitoring.     

儿童后颅窝肿瘤合并脑积水的治疗及预后影响因素分析

目的 探讨儿童后颅窝肿瘤合并脑积水患者行肿瘤切除术前对于脑积水的治疗是否影响术后脑积水的发生率,并分析术后脑积水发生的相关危险因素.方法 中山大学附属第一医院神经外科自2003年1月至2009年12月行肿瘤切除术治疗后颅窝肿瘤合并脑积水儿童患者63例,其中对术前脑积水行保守治疗43例,手术治疗20例.回顾性分析患者的临床资料并比较术前脑积水保守治疗组和手术治疗组患者术后脑积水的发生率,Logistic回归分析患者的性别、发病年龄、术前Evans指数、肿瘤病理类型、肿瘤切除程度、肿瘤生长部位等因素是否与术后脑积水的发生有关.结果 术后出现脑积水患者22例,其中术前脑积水保守治疗组14例(14/43,32.6%),术前脑积水手术治疗组8例(8/20,40.0%),2组比较脑积水发生率差异无统计学意义(P=0.564);Logistic 回归分析发现患者术前Evans指数、肿瘤生长部位、肿瘤切除程度与肿瘤切除术后脑积水的发生有关(P=0.029,p=0.036,P=0.038).结论 肿瘤切除术前脑积水的治疗并不能改变术后脑积水的发生率:术前Evans指数、肿瘤生长部位、肿瘤切除程度是肿瘤切除术后脑积水发生的危险因素.     

儿童后颅窝肿瘤合并脑积水的治疗及预后影响因素分析

目的 探讨儿童后颅窝肿瘤合并脑积水患者行肿瘤切除术前对于脑积水的治疗是否影响术后脑积水的发生率,并分析术后脑积水发生的相关危险因素.方法 中山大学附属第一医院神经外科自2003年1月至2009年12月行肿瘤切除术治疗后颅窝肿瘤合并脑积水儿童患者63例,其中对术前脑积水行保守治疗43例,手术治疗20例.回顾性分析患者的临床资料并比较术前脑积水保守治疗组和手术治疗组患者术后脑积水的发生率,Logistic回归分析患者的性别、发病年龄、术前Evans指数、肿瘤病理类型、肿瘤切除程度、肿瘤生长部位等因素是否与术后脑积水的发生有关.结果 术后出现脑积水患者22例,其中术前脑积水保守治疗组14例(14/43,32.6%),术前脑积水手术治疗组8例(8/20,40.0%),2组比较脑积水发生率差异无统计学意义(P=0.564);Logistic 回归分析发现患者术前Evans指数、肿瘤生长部位、肿瘤切除程度与肿瘤切除术后脑积水的发生有关(P=0.029,p=0.036,P=0.038).结论 肿瘤切除术前脑积水的治疗并不能改变术后脑积水的发生率:术前Evans指数、肿瘤生长部位、肿瘤切除程度是肿瘤切除术后脑积水发生的危险因素.     

Gamma-knife for treating pituitary adenomas in 501 cases： Retrospective case analysis

BACKGROUND: Gamma-knife is characterized by low risk and low death rate, without trauma, bleeding or infection. MRI has replaced CT as a method of location, and provides a good choice for treating pituitary tumors. OBJECTIVE: To analyze the effectiveness and complications of 501 cases with pituitary adenoma by using gamma-knife retrospectively. DESIGN: Case-analysis. SETTING: Gamma-knife Center, the 363 Hospital of Chinese PLA. PARTICIPANTS: A total of 501 cases were selected from Gamma-knife Center, the 363 Hospital of Chinese PLA from January 1997 to December 2002. All patients were certainly diagnosed with CT and MRI scanning. There were 186 males and 315 females. Their ages ranged from 15 to 84 years with the mean age of 39 years. All patients provided confirmed consent. METHODS: All 501 cases with pituitary adenomas were treated by gamma-knife or combined with operations. The average iso-dose curve was 50% (30%–65%), peri-dose was 14 Gy and the average target number was 5.17. ① At 35 months after treatment, patients received follow-up including clinical symptoms, imaging symptoms and endocrine symptoms. ② Patients who received second gamma-knife treatment were analyzed and their complications were observed after operation. MAIN OUTCOME MEASURES: ① Follow-up results of clinical symptoms, image and endocrine indexes; ② second gamma-knife treatment; ③ postoperative complications. RESULTS: Among 501 accepted patients, 275 cases were involved in the follow up of clinical symptoms, 154 in image symptoms and 98 in endocrine symptoms. ① Follow-up results of clinical symptoms, image and endocrine indexes: Follow up of clinical symptoms demonstrated that clinical symptoms of 169 cases were relieved, of 68 disappeared, and of 38 deteriorated. Follow-up of image symptoms indicated that pituitary tumor of 25 cases disappeared, of 84 shortened, of 42 not changed, and of 3 enlarged. Follow-up of endocrine symptoms suggested that endocrine of 50 cases was abnormal, of 29 recovery to normal value, and of 19 not changed obviously. ② Second gamma-knife treatment: At 6–24 months after gamma-knife treatment, 15 patients with pituitary tumor received second gamma-knife treatment; especially, one patient received for the three times. The conditions in details were recorded as follows: The peri-dose for the first treatment ranged from 8 to 12 Gy; in addition, that for the second one ranged from 6 to 12 Gy. ③ Postoperative complications: The complications were as follow: hypopituitarism occurred in 2 patients (0.7%); tumor apoplexy in 2 patients (0.7%); weakened eyesight in 5 patients (1.8%); 3 of which recovered with dehydration and hormone treatment; 2 patients received tumor resection and optical nerve decompression operation with dehydration and hormone treatment ineffectively. CONCLUSION: Gamma-knife is effective and safe for pituitary adenoma.     

Identification of risk factors for poor language outcome in surgical resection of glioma involving the arcuate fasciculus: an observational study

The arcuate fasciculus is a critical component of the neural substrate of human language function. Surgical resection of glioma adjacent to the arcuate fasciculus likely damages this region. In this study, we evaluated the outcome of surgical resection of glioma adjacent to the arcuate fasciculus under the guidance of magnetic resonance imaging and diffusion tensor imaging, and we aimed to identify the risk factors for postoperative linguistic deficit. In total, 54 patients with primary glioma adjacent to the arcuate fasciculus were included in this observational study. These patients comprised 38 men and 16 women(aged 43 ± 11 years). All patients underwent surgical resenction of glioma under the guidance of magnetic resonance imaging and diffusion tensor imaging. Intraoperative images were updated when necessary for further resection. The gross total resection rate of the 54 patients increased from 38.9% to 70.4% by intraoperative magnetic resonance imaging. Preoperative language function and glioma-to-arcuate fasciculus distance were associated with poor language outcome. Multivariable logistic regression analyses showed that glioma-to-arcuate fasciculus distance was the major independent risk factor for poor outcome. The cutoff point of glioma-to-arcuate fasciculus distance for poor outcome was 3.2 mm. These findings suggest that intraoperative magnetic resonance imaging combined with diffusion tensor imaging of the arcuate fasciculus can help optimize tumor resection and result in the least damage to the arcuate fasciculus. Notably, glioma-to-arcuate fasciculus distance is a key independent risk factor for poor postoperative language outcome. This study was approved by the Ethics Committee of the Chinese PLA General Hospital, China(approval No. S2014-096-01) on October 11, 2014.     

Hydrocephalus in posterior fossa tumors in children. Are there factors that determine a need for permanent cerebrospinal fluid diversion?

Objective  We searched for factors that could predispose towards persistent hydrocephalus in children with posterior fossa (PF) tumors in order to determine the need for permanent cerebrospinal fluid (CSF) diversion. Methods  The clinical records of 64 children who underwent surgery for PF tumors in the Pediatric Neurosurgery division of the Hospital of Clinics, Ribeirao Preto, Brazil, from 1990 to 2006, were retrospectively reviewed. The patients’ ages ranged from 3 months to 18 years. The factors evaluated included age at surgery, severity of hydrocephalus (ventricular index), tumor location, size of the tumor, extent of tumor resection, and histology. Results  Ventricular index, measured from the initial neuroradiological image, age at surgery, and location of the tumor were significantly associated with definitive postoperative CSF diversion (shunt or endoscopic third ventriculostomy), which was necessary for 34% of the patients. Conclusions  Young children with severe preoperative hydrocephalus and a midline tumor should be considered at risk when preoperative treatment decisions are made.     

Endoscopic third ventriculostomy in the treatment of hydrocephalus in posterior fossa tumors in children

OBJECT: The purpose of the present study is to assess the effectiveness of endoscopic third ventriculostomy (ETV) in children with hydrocephalus related to posterior fossa tumors. METHODS: Between September 1999 and December 2002, 63 children with posterior fossa tumors were treated at Santobono Hospital in Naples, Italy. Twenty-six patients had severe hydrocephalus. In order to relieve intracranial hypertension before tumor removal, 20 were treated with ETV, and 6 with ventriculo-peritoneal (VP) shunts. Twenty patients with mild hydrocephalus were treated with diuretics, corticosteroid agents, and early posterior fossa surgery, and 17 patients who did not have hydrocephalus were treated by elective posterior fossa surgery. Another 4 ETV were performed in the management of postoperative hydrocephalus. RESULTS: Preoperative ETV procedures were technically successful. One was complicated by intraventricular bleeding. The successful 19 preoperative ETV resolved intracranial hypertension before posterior fossa surgery in all cases. Three of these 19 patients developed postoperative hydrocephalus and were treated by VP shunt insertion after posterior fossa surgery. Out of the 4 ETV performed after posterior fossa surgery, only 2 were successful, both when the shunt malfunctioned. CONCLUSIONS: Endoscopic third ventriculostomy should be considered as an alternative procedure to ventriculo-peritoneal shunting and external ventricular draining for the emergency control of severe hydrocephalus caused by posterior fossa tumors, since it can quickly eliminate symptoms, and hence, can delay surgery scheduling if required. Even though ETV does not prevent postoperative hydrocephalus in all cases, it does protect against acute postoperative hydrocephalus due to cerebellar swelling. In addition, it eliminates the risks of cerebrospinal fluid (CSF) infection related to external drainage and minimizes the risk of overdrainage because it provides more physiological CSF drainage than the other procedures. Since postoperative hydrocephalus is very often physically obstructive, ETV should always be considered a possible treatment procedure.     

术前栓塞联合显微手术治疗后颅窝实性血管母细胞瘤的疗效分析

目的探讨术前栓塞肿瘤供血动脉联合显微手术治疗后颅窝实性血管母细胞瘤的临床疗效。方法回顾性分析2012年5月至2018年7月郑州大学附属肿瘤医院神经外科收治的13例后颅窝实性血管母细胞瘤患者的临床资料。所有患者开颅手术前72 h内均予肿瘤供血动脉栓塞,术后予伽玛刀治疗。总结术前栓塞和显微手术的技巧,并分析手术疗效。患者入院、出院时采用Karnoisky功能状态评分(KPS)评估患者的生命质量。结果开颅术前肿瘤的栓塞程度>80%者4例,60%~80%者8例,<60%者1例。1例患者栓塞术后行MRI检查可见脑干局部梗死,临床表现为中枢性面瘫、吞咽困难加重。13例患者中,肿瘤全切除11例,次全切除2例。术中出血量为(620±35)ml,手术时间为(6.5±1.1)h。13例患者术前的颅高压症状均于术后明显缓解。术后新发吞咽功能障碍2例,听力减退1例,新发中枢性面瘫1例。13例患者出院时的KPS为(85.8±4.9)分,较入院时[(76.6±11.3)分]有明显改善(t=3.969,P=0.002)。所有患者均获随访,随访时间为6个月至3年(中位随访时间为22.6个月),末次随访的KPS为(88.1±3.6)分,与出院时比较差异无统计学意义(t=2.065,P=0.062)。仅1例次全切除患者于术后9个月肿瘤增大,再次给予伽玛刀治疗后未进展;其余12例肿瘤均无复发。2例患者发生梗阻性脑积水,予以脑室-腹腔分流术治疗后症状缓解。结论对于后颅窝实性血管母细胞瘤,术前行肿瘤供血动脉的栓塞能有效减少术中出血,甚至可达到分块切除肿瘤,从而降低了手术风险,有助于提高手术效果。     

神经内镜治疗后颅窝囊肿合并脑积水31例分析

目的 探讨神经内镜治疗后颅窝囊肿合并脑积水的诊治方法。 方法 回顾性分析南方医院神经外科自2004年4月至2010年8月收治的31例后颅窝扩大囊室合并脑积水患者资料,所有患者均经头颅CT和MRI证实。其中后颅窝真性蛛网膜囊肿19例,Dandy walker畸形5例,布莱克囊肿2例,肿瘤术后囊肿5例。依据不同手术方式分成内镜手术组(14例)、开颅显微镜手术组（9例）和分流手术组（8例）,根据术后患者临床症状改善情况、影像学表现和相关并发症发生情况判定疗效。 结果 3组患者术后早期临床症状均有所改善。术后随访6个月～6年,复查头颅MRI显示28例患者后颅窝囊肿及脑室系统较术前有不同程度的缩小,其中内镜组有效率和并发症发生率分别为92.9％和14.3％,显微镜组分别为88.9％和33.3％,分流手术组分别为75.0％和50.0％。 结论 神经内镜是治疗后颅窝囊肿合并脑积水的一种安全、有效术式,相对显微镜下开颅手术和分流手术而言,操作灵活,并发症少,预后好,值得临床进一步推广。     

以癫癎为首发症状的低级别星形细胞瘤病人术后癫癎预后分析

目的探讨影响以癫癎为首发症状的低级别星形细胞瘤癫癎预后的因素。方法回顾性分析以癫癎为首发症状的低级别星形细胞瘤病例,经手术切除肿瘤1年后的癫癎症状改善情况,本组研究数据应用SPSS17．0统计软件进行卡方检验和多因素Logistic回归分析。结果术后癫癎预后为改良Engel I级102例（67．5％）,Ⅱ级以上49例（32．5％）。卡方检验显示：术前病人有语言障碍（P=0．038）、术前肿瘤累及岛叶（P=0．010）、肿瘤未全切除（P=0．001）对术后癫癎预后差异有统计学意义。多因素Logistic回归分析：术前病人有语言障碍（P=0．022）、术前肿瘤累及岛叶（P=0．007）及肿瘤未全切除（P=0．002）均为影响术后癫癎发作的独立危险因素。结论术前病人有语言障碍、术前肿瘤累及岛叶及肿瘤未全切除是影响以癫癎为首发症状的低级别星形细胞瘤病人术后癫癎预后的独立危险因素。     

后颅窝非囊结节型血管母细胞瘤术前栓塞的效果分析

目的探讨后颅窝非囊结节型血管母细胞瘤（HB）术前栓塞的安全性和有效性。 方法回顾性分析新疆医科大学第一附属医院神经外科中心肿瘤病区自2014年1月至2018年6月收治的12例后颅窝非囊结节型HB患者的临床资料,患者均行术前栓塞,栓塞后行显微神经外科手术切除肿瘤,观察栓塞后及术后并发症发生情况并采用KPS评分评价治疗效果。 结果后颅窝非囊结节型HB多支血管共同参与供血,本组患者完全栓塞5例,大部分栓塞5例,部分栓塞2例。栓塞后显微神经外科手术全切11例,肿瘤次全切1例。平均手术时间5.3 h,术中出血200~1500 mL,平均出血680 mL。1例患者术后后组颅神经麻痹,发生吸入性肺炎;1例出现颅内感染。术后KPS评分均≥90分,可进行正常活动。 结论术前栓塞是后颅窝非囊结节型HB安全有效的辅助治疗方法,可有效减少术中出血,缩短手术时间,减少手术并发症,提高患者术后生活质量。     

Treatment Outcome of Hydrocephalus Associated with Vestibular Schwannoma

Background and PurposeManaging hydrocephalus in patients with vestibular schwannoma (VS) is controversial. We evaluated the clinical factors associated with hydrocephalus.MethodsBetween 2000 and 2019, 562 patients with VS were treated at our institute. We applied endoscopic third ventriculostomy (ETV), external ventricular drainage (EVD), and ventriculoperitoneal (VP) shunts to patients with hydrocephalus. The relationships of patient, tumor, and surgical variables with the hydrocephalus outcome were assessed.ResultsPreoperative hydrocephalus (Evans ratio ≥0.3) was present in 128 patients. Six patients who received a preresectional VP shunt were excluded after analyzing the hydrocephalus outcome. Seven of the remaining 122 patients had severe hydrocephalus (Evans ratio ≥0.4). Primary tumor resection, VP shunting, ETV, and EVD were performed in 60, 6, 57, and 5 patients, respectively. The hydrocephalus treatment failure rate was highest in the EVD group. Persistent hydrocephalus was present in five (8%) and seven (12%) patients in the primary resection and ETV groups, respectively. Multivariate analysis revealed that severe hydrocephalus, the cystic tumor, and the extent of resection (subtotal resection or partial resection) were associated with hydrocephalus treatment failure.ConclusionsLarger ventricles and a higher cystic portion are predictive of persistent hydrocephalus. We recommend attempting near-total tumor resection in patients with VS.     

Analysis of CSF shunting procedure requirement in children with posterior fossa tumors

OBJECT: The authors analyze the factors that predispose to persistent hydrocephalus in children with posterior fossa tumors and compare their results and treatment policy with those described in the literature, particularly with regard to the higher postoperative shunt insertion rates, which have led some authors to the routine use of preoperative third ventriculostomy. METHODS: The clinical records of 180 children treated for posterior fossa tumors in the Department of Pediatric Neurosurgery of the National Institute of Neurosurgery, Budapest, Hungary, between 1990 and 2000 were retrospectively reviewed. CONCLUSIONS: The low postoperative shunt insertion rate in our series (15.5%) led us to believe that the routine use of preoperative third ventriculostomy is not entirely justified. Factors such as patient's age and tumor type, which showed a statistically significant association with the postoperative shunt requirement in our study, should be considered when the decision regarding treatment is made.