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。

Microsurgery for the fourth ventricle tumors in children

Objective To investigate the clinical characteristic and strategy of microsurgery for the fourth ventricle tumors in children. Methods The clinic data of 45 children with fourth ventricle tumors, who underwent microsurgery for the tumors from 1998 to 2009 in our hospital, were analyzed retrospectively, including the pathology, clinical manifestations, imaging examination, surgery treatment of the tumors and the patients＂ prognosis. Results Of 45 children with the tumors, 36 received total removal of the tumors and 9 subtotal or greatly partial. The pathological examination showed that of 45 children, 28 suffered from medulloblastomas, 14 ependymomas and 3 astrocytomas. The clinical symptoms were improved in 32 children, unchanged in 10 and deteriorated in 2 after the surgery. One patient died of the serious edema of the brain stem. The ventriculoperitoneal shunt was performed in 4 children because of hypereephalus after the surgery. Conclusions The primary symptoms in the children with the fourth ventricle tumors were variable. MRI is helpful to the diagnosis and surgery for the fourth ventricle tumor. The suitable mieroneurosurgical strategy were the key to improving the therapeutic effect on the fourth ventricle tumors in children.