第四脑室肿瘤的显微外科治疗

目的总结第四脑室肿瘤的显微外科治疗效果及手术策略。方法第四脑室肿瘤患者36例,均在显微镜下或神经内镜辅助下切除肿瘤。肿瘤全切除24例,次全切除12例。结果术后恢复良好13例,死亡3例,缄默症4例,脑积水16例,其中12例行侧脑室．腹腔分流术,4例行脑室心房分流术。术后随访：29例生活、学习良好,3例死亡,1例失访。结论正确及时的诊断、熟悉四脑室的显微解剖、选择合适的手术入路、熟练的显微手术技巧、适当应用神经内镜、积极处理术后脑积水是提高第四脑室肿瘤疗效的关键。     

原发脑室内神经鞘瘤2例报道及文献复习

目的 探讨原发脑室内神经鞘瘤的临床特点及治疗。方法 回顾性分析2例原发脑室内神经鞘瘤的临床资料,并结合文献进行分析。 结果 2例均为青年病人,影像学检查示脑室内占位明显,术前误诊为其他病变,开颅手术全切肿瘤,术后病理诊断证实为神经鞘瘤。术后随访1~3年,未见肿瘤复发。结论 原发脑室内神经鞘瘤非常罕见,基本为良性病变,影像表现多样,不具特异性,可出现囊肿、周围水肿、钙化、伴脑积水等多种表现,增强扫描均有不同程度强化,术前易误诊,手术全切率高,预后良好。     

儿童第四脑室肿瘤的显微外科治疗(附43例报告)

目的 探讨儿童第四脑室常见肿瘤的诊断和显微手术技巧.方法 回顾性分析2006~2010年手术治疗的43例儿童第四脑室肿瘤患者的临床表现与影像学等临床资料;根据肿瘤与小脑蚓部和第四脑室的关系,设计个体化手术入路切除肿瘤.结果 肿瘤全切除38例,次全切5例(为与第四脑室底粘连紧密者).绝大多数病例无明显并发症或并发症较轻,经治疗后好转.病理结果示髓母细胞瘤27例,室管膜瘤8例,星形细胞瘤7例(其中毛细胞型3例),神经细胞瘤(交界性)1例.髓母细胞及WHOⅢ级的室管膜瘤术后进行了全脑和脊髓放疗,次全切的室管膜瘤和星形细胞瘤进行了局部放疗.结论 儿童第四脑室肿瘤以髓母细胞瘤最多见,其次是室管膜瘤和星形细胞瘤;正确的入路选择和手术技巧是取得良好疗效、减少并发症的关键.     

儿童第四脑室肿瘤的诊断与外科治疗

目的对儿童第四脑室肿瘤的早期诊断、手术策略和技巧及术后并发症进行分析讨论。方法回顾性分析中国医大盛京医院1993年1月至2004年1月儿童第四脑室肿瘤手术病例37例。所有患儿均经显微手术治疗。男23例,女14例。年龄1岁零4个月至14岁,平均（7．1±0．5）岁。所有患儿术前、术后均行头颅CT和（或）MRI检查。结果本组手术全切除24例,次全切除10例,大部切除3例。症状较术前明显改善32例,无明显改善或加重5例;6例术后7d-2个月内行侧脑室-腹腔分流术。19例患者获得随访3-40个月,12例生活或学习良好,其中随访期内复发7例。对3岁以上的10例髓母细胞瘤,2例室管膜瘤切除术后行小剂量X线全脑脊髓神经轴放疗,5例星形胶质细胞瘤切除术后加化疗。结论儿童第四脑室肿瘤以髓母细胞瘤最多见,其次为室管膜瘤和星形细胞瘤。早期正确诊断,术中恰当的手术策略选择及切除程度、术后并发症恰当处理和有选择性放疗是影响儿童第四脑室肿瘤预后的关键因素。     

儿童第四脑室肿瘤显微外科治疗策略

目的探讨儿童第四脑室肿瘤的生物学特点及显微外科治疗策略。方法 1998年至2009年收治的儿童第四脑室肿瘤患者45例,对其病理特点、临床表现、影像学变化、手术操作和预后等方面进行回顾性分析。结果肿瘤全切除36例,次全切除及大部切除9例;术后病理示髓母细胞瘤28例,室管膜瘤14例,星形细胞瘤3例;术后临床症状好转32例,无改善10例,恶化2例,1例患者死于严重脑干水肿;术后复查有4例因脑积水行脑室-腹腔分流术。结论儿童第四脑室肿瘤首发症状多种多样,MRI对于诊断与手术有重要的意义,采取合适的显微神经外科策略是提高手术疗效的关键。     

显微手术治疗第四脑室肿瘤17例临床体会

目的分析显微手术治疗第四脑室肿瘤的临床方法与效果。方法将2010-07-2015-07河南中医药大学第一附属医院确诊的第四脑室肿瘤患者,均择期行显微手术治疗,对效果、术后并发症进行观察对比。结果本组14例患者行肿瘤全切术,3例患者行次全切术。术后出现并发症2例11.7%。其中幕上远隔硬膜外血肿1例,皮下积液1例。对症处理后均短期内转归,未对患者预后治疗产生不良影响。结论显微手术治疗第四脑室肿瘤的临床效果确切,术者需了解第四脑室及脑干的重要神经结构,注重对脑干功能的保护,脑水肿患者预先行侧脑室外引流,以巩固显微术下肿瘤病灶的切除效果。     

原发性腹膜后神经鞘瘤的诊断与显微外科手术治疗

目的探讨原发性腹膜后神经鞘瘤的诊断和显微外科手术治疗的优缺点。方法对22例原发性腹膜后神经鞘瘤患者的诊断和显微外科手术切除的资料进行回顾性分析。结果 22例患者中肿瘤全切17例(77.3%),次全切5例(22.7%);无严重手术并发症;出血量少,平均每例220 ml。结论原发性腹膜后神经鞘瘤早期诊断困难,术前确切病理诊断依赖肿瘤穿刺活检;显微外科手术切除是一种安全有效的手术方式。     

第四脑室脉络丛肿瘤的诊断及治疗（附9例分析）

目的总结第四脑室脉络丛肿瘤的诊治经验。方法回顾性分析9例第四脑室脉络丛肿瘤病例的临床表现、影像学特点及手术治疗方法。结果肿瘤全切除7例,次全切除2例。病理证实脉络丛乳头状瘤7例,脉络丛乳头状癌2例。无手术死亡及严重术后并发症发生。结论第四脑室脉络丛肿瘤以良性居多,应积极行手术治疗,手术切除是首选治疗方法。     

原发性脑室内肿瘤的临床特点与治疗

目的探讨原发性脑室内肿瘤的临床特点和治疗。方法回顾性分析14例原发性脑室内肿瘤的临床表现、心电图和影像学特点及手术情况。结果室管膜瘤9例,脑膜瘤3例,室管膜下巨细胞星形细胞瘤1例,胶样囊肿1例。全切除8例,次全切除4例,大部分切除2例。围手术期死亡2例,术后恢复良好12例。3例失随访,余9例随访2月至4年,平均随访23．125个月,2例室管膜瘤复发,其中1例死亡,其余7例预后良好。结论原发性脑室内肿瘤缺乏特征性的临床表现,应重视患者的主观症状,避免漏诊;原发性脑室内肿瘤患者心电图异常率高,应引起重视;显微手术是治疗原发性脑室内肿瘤的首选方法。     

第四脑室卵黄囊瘤1例报告并文献复习

目的 探讨颅内卵黄囊瘤的临床特点、影像学特征及治疗方法,提高对颅内卵黄囊瘤(YST)的认识。方法 回顾性分析中国医科大学附属盛京医院神经外科手术治疗的1例经病理证实的第四脑室卵黄囊瘤患儿的临床资料;并对相关文献进行复习。结果 患儿行开颅显微镜下手术全切除肿瘤,术中见肿瘤基底位于小脑蚓部,充满第四脑室,约3 cm×3 cm×4 cm大小,色暗红,供血丰富,质地较软;仔细分离肿瘤周边,逐渐深入,分块完整切除肿瘤。病理检查为卵黄囊瘤。术后患儿恢复良好,随访1个月未见复发,目前仍在随访中。结论 颅内第四脑室卵黄囊瘤临床非常罕见;其病因尚不明确,临床表现与肿瘤大小和部位有关,影像学检查有一定诊断价值,血清及脑脊液甲胎蛋白(alpha fetoprotein,AFP)浓度升高。目前治疗大多采用手术完整切除肿瘤,术后联合放化疗。因第四脑室卵黄囊瘤的恶性程度较高,故预后差。     

Primary intraventricular schwannomas

Schwann cell tumors arising within the neuraxis and in an intraventricular location are an exceedingly rare tumor entity of the brain. The authors present the first case of a cellular intraventricular schwannoma occurring in the fourth ventricle. The pertinent literature is reviewed.A 71-year-old female was admitted to the hospital with an incidental finding of a ventricular tumor. Computed tomography scanning and magnetic resonance imaging revealed a solitary contrast enhancing exophytic mass lesion within the fourth ventricle. Microsurgical excision via a midline suboccipital craniotomy and tonsillo-nodular approach led to complete tumor removal. Subsequent histopathological examination confirmed the diagnosis of an unsuspected primary intraventricular cellular schwannoma.A unique case of an initially unexpected benign schwannoma arising from the fourth ventricle that could be successfully treated by microsurgery and finally confirmed by histopathological analysis with excellent patient outcome is presented. Although highly uncommon, Schwann cell tumors of both benign and malignant nature may present as ventricular lesions and should be included as a differential diagnosis in patients with either solely intraventricular masses or intra- and extraaxial tumors with extension to the ventricles.     

Midline cerebellar cystic schwannoma : a case report.

An extremely unusual case of a cystic schwannoma in the region of the inferior vermis and posterior to the fourth ventricle in a fifteen year old boy is reported. The cystic tumour caused partial obstruction to the outflow of cerebrospinal fluid from fourth ventricle and resulted in development of supratentorial hydrocephalus. On investigations, the schwannoma simulated a Dandy-Walker cyst. The boy presented with symptoms of increased intracranial pressure. On surgery, the lesion was not arising from any cranial nerve, nor was it attached to brain parenchyma, blood vessel or to the dura. The possible histogenesis of the cystic schwannoma in a rare location is discussed.     

Yolk sac tumor in the fourth ventricle: A case report

The nongerminomatous germ cell tumor occurring in the fourth ventricle is extremely rare. A 9-year-old boy presented with symptoms of obvious headache, projectile vomiting, diplopia and motor weakness. MRI scanning revealed lesions occupying the fourth ventricle, with dual-lateral ventricle expansion after gadolinium administration. Suboccipital craniectomy was performed and the tumor was removed by block resection. Twice intraoperative biopsy specimens revealed fiber vascular tissue and hemangioma. Histological examination revealed that the tumor consisted of loose network structures and Schiller–Duval bodies. Immunohistochemical study showed that the primitive germ cells were positive for placental alkaline phosphatase, alpha-fetoprotein, cytokeratin, vimentin, but negative for glial fibrillary acidic protein. The histological diagnosis was pure yolk sac tumor. Two years after surgery, he has suffered no tumor recurrence. A combination of surgical treatment, radiation and chemotherapy is mandatory.     

An unusual anatomic and geographic location of primary germinoma of the fourth ventricle

Intracranial germinoma is most commonly found in the pineal and suprasellar regions. The medulla oblongata and fourth ventricle are rare sites of primary germinoma, with only 12 previous patients reported, all from the Far East. To our knowledge, we report the first patient from Europe. A 25-year-old female of Afro-Caribbean origin presented with several weeks of worsening migraines, dizziness, tachycardia and veering to the right whilst walking. MRI revealed a lesion in the fourth ventricle, which was treated with surgical debulking and post operative radiotherapy. Two months following completion of radiotherapy, MRI showed almost complete resolution of the enhancing disease within the primary tumour area and no intraspinal pathological enhancement. This patient highlights the importance of considering germinoma in the differential diagnosis of all medullary masses with extension into the fourth ventricle irrespective of geographic location.     

Glossopharyngeal schwannoma : a case report and review of literature

We report a rare case of glossopharyngeal schwannoma whose clinical presentation and the radiological work up suggested an acoustic schwannoma. The diagnosis was made at surgery, once attachment to ninth cranial nerve was seen. The clinical presentation, radiological features and surgical findings of the glossopharyngeal schwannoma are presented along with the review of literature.     

Schwannoma of the hypoglossal nerve presenting as a syndrome of Collet-Sicard

Collet-Sicard is a rare syndrome that consists of the palsy of all the lower four cranial nerves. We describe this entity in relation with a schwannoma of the hypoglossal nerve. A 45 year-old-patient was admitted to the hospital referring hoarseness and difficulty in swallowing for two weeks. On neurological examination, the patient exhibited palsy of the ninth, tenth, eleventh and twelfth nerves. This is a syndrome of Collet-Sicard. The cranial MRI revealed a small intracranial and extracranial tumor adjacent to the hypoglossal foramen. The tumor involved the jugular foramen and was moderately enhanced with gadolinium The patient underwent surgical removal. The pathologic examination of the surgical specimen confirmed the diagnosis of a schwannoma of the hypoglossal nerve. We have carried out a research of the Collet-Sicard syndrome and of its aetiology. Although schwannoma the hypoglossal nerve is a rare disorder we consider that this entity should be included in the differential diagnosis of the Collet-Sicard syndrome.     

Meningioma of the fourth ventricle.

Meningiomas are primary meningeal based tumors of the central nervous system that rarely are located strictly within the fourth ventricle. We report a 72-year-old man operated upon for such a tumor. The pre-operative magnetic resonance images revealed a well circumscribed mass in the fourth ventricle that exhibited a low signal on T1-weighted magnetic resonance images and homogenously enhanced with gadolinium. By light microscopy the tumor was composed of tightly packed spindle cells separated by collagen. Immunohistochemistry showed the tumor cells to be positive for vimentin and epithelial membrane antigen, and negative for glial fibrillary acidic protein. Electron microscopy revealed typical findings of meningioma, including interdigitating cell processes, desmosomes, and intermediate filaments. Although rare, fibroblastic meningioma must be included in the differential diagnosis of a fourth ventricular spindle cell tumor in elderly patients.     

Pediatric intramedullary schwannoma without neurofibromatosis

Pediatric intramedullary schwannoma without neurofibromatosis is extremely rare with only five cases reported so far. We present this rare finding in an 8-year-old boy who presented with a sudden onset of weakness in all limbs. An intraoperative diagnosis of schwannoma enabled us to carry out a total excision of the tumor, which resulted in near complete recovery at 18 months follow-up. Although rare, this diagnosis should be considered when a child presents with a solitary intramedullary tumor, since its total resection can be achieved improving surgical outcome.     

Cerebellopontine angle subependymoma without fourth ventricle extension: An uncommon tumor in a rare location

Subependymomas are benign tumors that occur predominantly in the ventricular system. We describe a case of a 57‐year‐old man with a large cerebellopontine angle (CPA) tumor which expanded into the jugular foramen. Complete surgical excision of the tumor was achieved through a retrosigmoid approach and the histopathological diagnosis was subependymoma. Subependymomas located exclusively in the CPA without extension into the fourth ventricle are extremely rare. The mainly pathological features and the difficulty in correctly diagnosing these cases preoperatively, even with MRI, are discussed.     

Cystic Giant Sacral Schwannoma Mimicking Aneurysmal Bone Cyst : A Case Report and Review of Literatures

To present a rare case of a cystic giant schwannoma of the sacrum mimicking aneurysmal bone cyst (ABC). A 54-year-old man visited our institute complaining left leg weakness and sensory change for several years. Magnetic resonance imaging revealed a large multilocular cystic mass with canal invasion and bone erosion confined to left S1 body. The lesion showed multiple septal enhancement without definite solid component. Initially the tumor was considered as ABC. The patient underwent grossly-total tumor resection with lumbosacral reconstruction via posterior approach. The tumor was proved to be a cystic schwannoma. The postoperative course was uneventful and the patient was relieved from preoperative symptoms. We present a rare case of pure cystic giant schwannoma confined to sacrum mimicking ABC. The surgical treatment is challenging due to the complex anatomy of the sacrum. Schwannoma should be considered in the differential diagnosis of osteolytic sacral cysts.