儿童颅内脑膜瘤19例报告

Intracranial meningiomas in children:a report of 19 cases

目的 分析总结儿童颅内脑膜瘤的临床特点及治疗效果。方法 经手术和病理证实15岁以下儿童脑膜瘤 19例 ,其中男 9例 ,女 10例。年龄 6～ 15岁 ,平均 10 .9岁。临床表现以颅内压增高 (11例 )、颅神经麻痹 (7例 )和癫痫 (6例 )为主。CT和MRI检查发现肿瘤钙化 4例 ,占 2 1.5 %(4/19) ,囊变 3例 16 .5 % (3/19) ,出血 1例 5 .2 % (1/19)。肿瘤位于大脑凸面 4例 ,侧脑室 3例 ,岩斜区 3例 ,侧裂 2例 ,鞍区 2例 ,中颅窝底 2例 ,矢状窦旁、大脑镰及枕大孔各 1例。术中见肿瘤与硬脑膜明显粘连 5例 ,贴近硬脑膜但无明显粘连 9例 ,2例侧裂脑膜瘤与硬脑膜完全无关 ,侧脑室 3例起源于脉络丛组织。病理报告纤维型脑膜瘤 8例 ,内皮型脑膜瘤 5例 ,砂粒型脑膜瘤 2例 ,混合型脑膜瘤 1例 ,非典型脑膜瘤 1例 ,未分类 2例。结果 肿瘤全切除 15例 ,不全切除 4例 ,无手术死亡。随访 9例 (6个月～ 4年 ) ,能正常参加学习和劳动者 5例 ,有癫痫发作 2例 ,肿瘤复发 2例。结论 儿童颅内脑膜瘤的发病率无女性优势 ,肿瘤的发生部位与成人不同 ,肿瘤与硬脑膜关系不密切。

Objective To study the clinical features and treatment results of childhood meningioma.Methods Nineteen cases (male 9,female 10) under 15 years of age with meningiomas confirmed by operation and pathology were reported.The tumors were located in the convexity (4),lateral ventricle (3),petrous portion (3),Sylvian fissure (2), sellar region (2),the middle cranial fossa (2),the parasagittal (1),cerebral falx (1),and foramen occipital magnum (1).Results Fifteen patients underwent complete resection whereas 4 had incomplete resection.There was no operative mortality.Nine children were followed up (6 months to 4 years),2 children had recurrence of tumors.Conclusions Meningioma is rare in children.Girls are not affected more often than boys.Tumor locations that are rare in adults are more common in children.Absence of dural attachment is more common in children than in adults. Whenever feasible every effort should be made to achieve total resection of the tumor during the first operation.