儿童第四脑室肿瘤的诊断与外科治疗

The diagnosis and microsurgical treatment of the fourth ventricular tumors in children

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。

Objective To analyze the diagnosis.differential diagnosis, microsurgical treatment and clinical outcome in the fourth ventricular tumors in children. Methods From Jan. 1993 to Jan. 2004, 37 patients of the fourth ventricular tumors in children underwent microsurgery by suboccipital approach. The clinical manifestations, image findings, surgical strategies and prognosis were summarized and analyzed retrospectively. Results Total resection was performed in 24 patients, subtotal in 10 patients, partially removed in 3 patients. 10 patients with medulloblastomas and 2 patients with ependymomas underwent radiotherapy only when at least 3 years old. 5 patients with astrocytomas received chemotherapy. In the 19 patients who were followed up, 12 cases lived with a normal life and study, tumor recurred in 7 cases during follow-up periods. Conclusions Medulloblastoma accounts for the main part of the fourth ventricular tumors in children followed by ependymomas and astrocytomas. Early correct diagnosis .techniques of microsurgery, total resection and post-operative radiotherapy play a key roles on affecting the prognosis of these kinds of tumors.