以颅脊管型肿瘤为表现的成人第四脑室巨大室管膜瘤的手术治疗

MICROSURGICAL TREATMENT OF CRANIAL-CERVICAL TYPE GIANT EPENDYMOMA WITHIN THE FOURTH VENTRICLE IN ADULT PATIENTS

目的 探讨第四脑室巨大室管膜瘤的影像学特征、手术切除情况及预后。方法 回顾性分析了 2 2例疝入颈椎管的巨大四脑室室管膜瘤病人的临床资料。所有病人术前均进行了磁共振成像 (MRI)检查 ,16例还进行了CT检查 ,所有肿瘤除占据四脑室外 ,还经四脑室正中孔疝入颈椎管 ,深达C2 或C3 平面。结果 所有病人接受枕下和C1 3 后正中入路肿瘤切除术 ,全切除 2 0例 ,近全切除 2例 ,术后 6例病人接受放疗。平均随访 5 5年 ,1例复发又行手术切除 ,其他病人无复发 ,5年存活率 10 0 % ,所有病人均恢复正常工作和生活。结论 颅脊管型四脑室巨大室管膜瘤是一种预后较好的肿瘤 ,手术全切除率高 ,复发率低 ,术后结合放疗可以获得理想的预后。

OBJECTIVE TO STUDY THE NEUROIMAGING CHARACTERISTICS, MICROSURGICAL TREATMENT AND PROGNOSIS OF CRANIAL-CERVICAL TYPE GIANT EPENDYMOMA WITHIN THE FOURTH VENTRICLE IN ADULT PATIENTS. METHODS THE CLINICAL DATA OF 22 PATIENTS WITH CRANIAL-CERVICAL TYPE GIANT EPENDYMOMA WITHIN THE FOURTH VENTRICLE WERE RETROSPECTIVELY ANALYZED. THE SUBOCCIPITAL AND C 1-3 POSTERIOR MIDLINE APPROATHODSCH WERE PERFORMED IN ALL PATIENTS.RESULTS THE TUMOR OF ALL PATIENTS NOT ONLY OCCUPIED THE CAVITY OF THE FOURTH VENTRICLE BUT ALSO PROTRUDED INTO THE CERVICAL CANAL THROUGH THE FORAMEN OF MAGENDIE AND EXTENDED TO THE CERVICAL 2 OR CERVICAL 3 LEVEL. THE TUMOR WAS TOTALLY REMOVED IN 20 PATIENTS, AND SUBTOTALLY REMOVED IN 2. SIX PATIENTS RECEIVED RADIOTHERAPY POSTOPERATIVELY. THE TIME OF MEAN FOLLOW-UP OF ALL PATIENTS WAS 5.5 YEARS. ONE PATIENT UNDERWENT A SECOND OPERATION 5 YEARS AFTER THE FIRST SURGICAL PROCEDURE IN OTHER HOSPITAL DUE TO TUMOR RECURRENCE. THE 5-YEAR SURVIVAL RATE WAS 100%. ALL PATIENTS RECOVERED THEIR NORMAL LIFE OR WORK. CONCLUSION CRANIAL-CERVICAL TYPE GIANT EPENDYMOMA WITHIN THE FOURTH VENTRICLE IN ADULT PATIENTS HAS A GOOD PROGNOSIS. THE SURGERY WITH POSTOPERATIVE ADJUVANT RADIOTHERAPY CAN OBTAIN A OPTIMAL RESULTS.