桥小脑角区巨大室管膜瘤的手术治疗及预后分析

目的 研究桥小脑角区室管膜瘤的临床特点、治疗方式及预后.方法 回顾性分析桥小脑角区巨大占位病变9例,男5例,女4例,年龄9～24岁,平均15.6岁,临床主要表现眩晕、步态不稳和颅高压症状.术前头部MRI及增强显示瘤体主要位于桥小脑角区,瘤体巨大,向上累及桥小脑角区顶层,向下累及桥小脑角区底层,向内侧明显压迫脑干,术前影像学检查均无法明确肿瘤性质.手术均采用乙状窦后手术入路,术中分块切除肿瘤.结果 手术全切肿瘤7例,近全切除1例,大部切除1例.术后病理证实均为室管膜瘤.术后患者恢复状态良好,无手术死亡,术后并发症主要为：三叉神经麻痹1例,吞咽困难加重后又缓解1例,有2例均在术后3d出现急性神经源性肺水肿,经紧急抢救后病情逐渐稳定,痊愈出院.结论 桥小脑角区巨大室管膜瘤,多以青少年患者发病为主,该部位室管膜瘤起源于第四脑室侧孔处之室管膜细胞,乙状窦后手术入路和术中分块切除肿瘤,减少脑干的牵拉和防止脑干过快复位可有效防止术后并发症的发生,效果良好.

Treatment and prognosis of ependymoma located in cerebellopontine angle area

Objective To study the clinical characteristics, treatment and prognosis of cerebellopontine angle ependymoma. Methods We retrospectively analyzed huge cerebellopontine angle lesions in 9 cases, 5 males and 4 females, aged 9 years-24 years, mean age 15.6 years. The clinical manifestations included in dizziness, ataxia, and intracranial hypertension. Preoperative MRI displayed the tumor mainly located in the cerebellopontine angle area, its volume was huge, involving the top level of cerebellopontine angle upwards, involving the bottom of cerebellopontine angle downward, and compressing brainstem obviously inward. Confirmed diagnosis could not obtain according to the preoperative imaging studies. Retrosigmoid approach was used to remove of the tumor step wisely. Results The total removal of the tumor surgery in 7 cases, 1 case of near--total resection, subtotal resection in 1 case. They were pathologically confirmed ependymoma. Postoperative recovery was in good condition, no operative mortality. The postoperative complications included in trigeminal nerve paralysis of 1 case, dysphagia heavier then ease of 1 case, there were two cases that presented acute neurogenic pulmonary edema 3 days after operation, the condition gradually stabilized after an emergency rescue. Conclusions They were mostly adolescence patients who were easy to have the huge cerebellopontine angle ependymoma. These tumors originated from the ependymal cells located in the foramen of Magendie of the fourth ventricle. Via a retrosigmoid approach, resecting tumors partitionedly, reducing traction and prevent the brainstem fast reset are effective in preventing the occurrence of postoperative complications, the effect is good.