侧脑室室管膜下室管膜瘤的诊断与治疗

目的研究侧脑室室管膜下室管膜瘤临床与影像学特点及其手术治疗效果,探讨其诊断及处理方法.方法回顾性分析了本科1998年5月至2003年5月间,12例经手术病理证实的侧脑室室管膜下室管膜瘤病例.结果侧脑室室管膜下室管膜瘤多见于中年,影像学表现为:CT平扫呈等或低密度,增强扫描强化不明显;MRI T1WI呈等或略低信号,T2WI呈高信号;MRI增强后见肿瘤无明显强化.手术全切11例,次全切除1例.随访9例,均无复发.结论侧脑室室管膜下室管膜瘤好发于中年.临床上遇到较长的病史,CT平扫呈等或低密度,MRI T1WI像呈等或略低信号,T2WI像呈高信号;CT、MRI增强后见无明显强化,位于侧脑室内肿瘤,应该考虑侧脑室室管膜下室管膜瘤的诊断.手术全切肿瘤,预后好,术后无需放疗.

Diagnosis and treatment of subependymomas of the lateral ventricles

Objective To study clinical presentation, neuroimaging features, treatment, and follow up of subependymomas of the lateral ventricles.Methods The data from 12 pathologically proved cases of subependymomas of the lateral ventricles were analyzed retrospectively, and a review of relevant literature was conducted.Results There were 7 male and 5 female patients ranging in age from 27 to 60 years (mean 45.3 years). Ten patients presented with headache and six had signs of raised intracranial pressure, two others were found incidentally during neuroimaging investigations. Neuroimaging characteristics of these tumors included iso/hypodensity with minimal enhancement on computerized tomography (CT), or iso/hypointensity on T 1 weighted and hyperintensity on T 2 weighted magnetic resonance images (MRI). The usual finding on MRI was of no or scarce contrast enhancement. Total resection was obtained in 11 patients and subtotal resection in 1 patient. No patients received postoperative radiation therapy. Nine patients had been followed up from 0.5 to 5.1 years (mean 3.1 years), after surgery. All followed patients have been doing well.Conclusion The suspicion of a subependymoma should arise when a patient in middle age with long clinical history presents an intraventricular tumor isodense on CT and isointense in T 1 and hyperintense in T 2 on MRI, with scarce or discrete contrast enhancement . Surgical treatment is indicated in symptomatic subependymomas of the lateral ventricles and usually allows complete tumor removal. The prognosis is usually good, also without postoperative irradiation.