儿童第四脑室肿瘤手术治疗29例报告

Surgical treatment of children's 4th ventricle tumors:report of 29 cases

目的 提高儿童第四脑室肿瘤的手术治疗效果。方法 回顾性分析我科手术治疗的 2 9例儿童第四脑室肿瘤的临床资料。结果 肿瘤全切除 18例 ,近全切除 5例 ,大部切除 6例。术后病理证实髓母细胞瘤 13例 ,室管膜瘤 9例 ,脉络丛乳头状瘤 3例 ,星形细胞瘤 3例 ,皮样囊肿 1例。术后脑积水 8例 ,其中 6例行侧脑室 -腹腔分流术。术后颅内感染 9例 ,2例死于颅内感染。随访 2 7例 ,随访时间 10天至 7年 ,18例恢复正常生活 ,4例肿瘤1年内复发 ,2例再次手术切除。结论 术前MRI检查明确肿瘤位置 ,应用显微外科技术 ,积极处理术后脑积水 ,预防颅内感染等是提高手术疗效的关键。

Objective To improve the surgery for 4th ventricle tumor in child patients.Methods From April 1995 to June 2003, the 29 cases of children's 4th ventricle tumor operated in our hospital were analyzed retrospectively.Results 18 cases got the tumors totally removed, 5 cases subtotally, and 6 cases partially. The histological diagnosis showed 13 cases of medulloblastoma, 9 ependymoma, 3 choroid plexus papilloma, 3 astrocytoma and 1 dermoid cyst. Postoperative hydrocephalus developed in 8 patients, and ventriculoperitoneal shunt was done in 6 of them. 9 patients developed intracranial infection, and 2 of them died of it. 27 of the 29 patients were followed up (10 days to 7 years).Most of them enjoyed normal life; 4 tumors recrudesced within 1 year, with 2 of them removed again.Conclusion To obtain better results of the surgical treatment, preoperative MRI to show the site of the tumor, use of microsurgical technique, management of postoperative hydrocephalus and prevention of intracranial infection are all necessary.