第四脑室室管膜瘤的显微外科治疗

目的：探讨第四脑室室管膜瘤的显微外科治疗。方法：通过显微外科技术切除１６例第四脑室室管膜瘤：其中手术切除１１例,近全切除５例。结果：存活１５例,死亡１例,肿瘤基底附着四室底上部（髓纹以上）１０例全切除９例,近全切除１例,肿瘤基底附着下部（髓纹以下）６例,全切除２例,近全切除４例。结论：作者认为肿瘤基底附着四室底髓纹以下并向下生长者手术难以全切除,术中避免脑干损伤是手术成功的关键。     

导航系统辅助显微外科技术治疗脑室肿瘤15例报告

目的 探讨脑室肿瘤外科手术时的病灶及周围结构的定位和报道显微手术的临床效果。方法 通过导航系统辅助下显微外科手术治疗脑室肿瘤１５例,其中侧脑室肿瘤９例,第三脑室肿瘤４例,第四脑室肿瘤２例,术后进行随访和分析。结果 １５例定位准确,肿瘤全切除１２例,次全切除３例,无明显的并发症发生,无死亡。结论导航系统辅助下显微外科手术能有效地减低手术的创伤,能最大限度地切除肿瘤,术后恢复快,治疗效果好。     

经小脑延髓裂入路显微手术切除儿童第四脑室肿瘤

目的 报道经小脑延髓裂入路显微外科手术切除儿童第四脑室肿瘤的临床疗效。方法 采用枕下正中切口、小脑延髓裂入路在手术显微镜下切除第四脑室肿瘤18例。结果 手术治疗18例，其中肿瘤全切除13例，近全切除5例。术后无l例出现小脑性缄默综合征。出现脑积水3例，2例经行侧脑室．腹腔分流后好转，l例因急性梗阻性脑积水死亡。结论 经小脑延髓裂入路，不需切开小脑蚓部，可避免损伤正常小脑组织，应用显微外科技术有助切除第四脑室肿瘤，提高手术疗效。     

第四脑室肿瘤的显微手术治疗

目的探讨第四脑室肿瘤的显微手术方法. 方法 2000年1月～2003年6月我院对29例第四脑室肿瘤采用显微手术治疗,5例因肿瘤侵犯上蚓,瘤体接近皮层部采用小脑蚓部入路,余24例均经小脑延髓裂入路,显微手术切除肿瘤. 结果肿瘤全切除23例,次全切除6例.术后并发症:上消化道出血2例,小脑缄默征1例,第四脑室血肿1例,远隔部位硬膜外血肿1例,呼吸不规则1例.19例随访3～12个月,平均5.5月,肿瘤无复发. 结论术前正确判断肿瘤性质及其基底部所在位置,选择适当的手术入路,熟练掌握第四脑室的显微解剖是手术成功的关键.     

第四脑室肿瘤的显微外科治疗

目的探讨第四脑室肿瘤手术入路和显微手术技巧,以提高第四脑室肿瘤的手术疗效。方法84例第四脑室肿瘤患者,行显微镜下切除肿瘤、后颅窝骨瓣成形及复位术。其中,61例采用正中孔-小脑蚓部入路,19例采用小脑延髓裂入路,4例取正中孔-小脑蚓部与小脑延髓裂联合入路。术前行侧脑室外引流4例,术中行侧脑室-枕大池分流3例,术后行侧脑室外引流术1例。结果本组全切除肿瘤63例(75.0%),次全切除21例(25.0%),无手术死亡病例。术后并发症:上消化道出血6例,小脑缄默症2例,四脑室血肿1例,脑积水1例,颅神经功能障碍1例。随访82例,平均38.4个月,死亡9例。结论术前正确判断肿瘤性质及其基底部所在位置,选择适宜的手术入路,熟练应用显微外科技术,是手术成功治疗的第四脑室肿瘤关键。     

侧脑室肿瘤的诊断与显微手术治疗

目的 总结分析侧脑室肿瘤的临床诊断要点及显微手术治疗方法.方法 回顾性分析经影像学检查、显微手术治疗和病理结果证实的62例侧脑室内肿瘤患者的临床资料.结果 肿瘤全切45例,次全切除11例,大部切除6例.术后死亡2例,脑室内血肿2例,行二次手术清除血肿.肿瘤位于左侧侧脑室40例,右侧侧脑室22例.其中脑膜瘤29例,星形细胞瘤9例(间变性星形细胞瘤5例),室管膜瘤7例(室管膜下瘤2例、恶性室管膜瘤1例),中枢神经细胞瘤6例,胶质母细胞瘤6例,脉络丛乳头状瘤4例,表皮样囊肿1例.术后随访43例,术后6个月Karnofsky评分70分以上31例,以下12例.结论 脑室内肿瘤多数为良性肿瘤,诊断有赖于影像学检查,显微手术切除是其主要治疗方法.     

颈髓髓内肿瘤显微手术治疗32例

目的 总结颈髓髓内肿瘤显微外科手术治疗的临床经验.方法 回顾性分析应用显微外科手术切除的32例颈髓髓内肿瘤的临床资料.显微镜下分离蛛网膜,于脊髓最薄弱处或后正中沟锐性切开,肿瘤与脊髓之间有可区分界面者,从肿瘤上、下极锐性分离,整块切除肿瘤;肿瘤与脊髓之间无可区分界面者,瘤内分块部分切除病变.结果 32例颈髓髓内肿瘤中,星形细胞瘤18例,肿瘤全切除3例,次全切除11例,部分切除或活检4例;髓内室管膜瘤13例,肿瘤全切除9例,次全切除4例;血管网织细胞瘤1例,仅行减压.术后无并发症发生.结论 应用显微外科手术切除可提高颈髓髓内肿瘤治疗效果和降低并发症的发生.     

第四脑室巨大脑膜瘤及显微手术

随着显微外科的发展,应用显微外科技术切除脑部肿瘤已越来越受到重视和关注[1,2]。第四脑室脑膜瘤极罕见,由于该肿瘤早期诊断困难,同时手术切除难度大,应用显微外科手术可全部切除肿瘤,且可减少或避免术后并发症,从而获得较好的疗效。我科于1998年12月收治1例巨大的第四脑...     

远外侧入路显微切除斜坡和枕大孔区腹侧肿瘤

目的 探讨斜坡、枕大孔区腹侧病变的手术方法和远外侧入路手术适应证。 方法 选择斜坡和枕大孔区腹侧病变２２例,其中脊索瘤１０例,脑膜瘤４例,舌下神经鞘瘤４例,椎－基底动脉汇合处动脉瘤２例,软骨肉瘤和纤维肉瘤各１例。３例肿瘤下极达颈２水平。依据需要磨除枕骨髁１／３或全部及其它骨块。２例侵入咽后壁的脊索瘤先经远外侧入路切除颅内部分肿瘤,再二期经口咽入路切除咽后壁部分。 结果 显微手术全切除１８例,次全切     

49例原发性肺肉瘤的诊断与外科治疗

目的 总结原发性肺肉瘤的外科治疗经验,提高诊治水平。方法 手术治疗４９例中肺叶切除或袖式肺叶切除３２例,全肺切除１１例,局部切除３例,手术探查３例。病理类型：恶性纤维组织细胞瘤１３全,纤维肉瘤９例,癌肉瘤９例,恶性血管外皮细胞瘤７例,肺胚瘤５例,平滑肌肉瘤４例,恶性间皮细胞瘤和非何杰金氏淋巴瘤各１例。结果 手术死亡２例,全组生存期中位数为１９个月,３年生存率１９％,５年生存率１２％;２年死亡率６７     

Surgical treatment for choroid plexus tumors in the fourth ventricle: brain stem infiltration hinders total extirpation

The significance of surgery for choroid plexus tumors is well established, but surgical resection of those in the fourth ventricle has not been evaluated. This study reviewed five consecutive patients with choroid plexus tumors in the fourth ventricle treated in our institute between 1996 and 2005, focusing on the factors that hindered total extirpation. Two cases were choroid plexus papillomas, and three cases were choroid plexus carcinomas. Preoperative T2-weighted magnetic resonance imaging showed a diffuse high-intensity lesion in the brain stem in four patients. Infiltration into the fourth ventricle floor was apparent in all five patients during surgery, which hindered total resection of the tumors without neurological deterioration. Intraoperative bleeding was well controlled in all five patients by cauterizing the feeding arteries at the early stage of surgery through the telovelar approach. Performance status was improved in all patients postoperatively. All patients with choroid plexus carcinomas underwent radiation therapy after the surgical removal. No patient suffered tumor progression within the follow-up of 24–129 months (mean 64 months). Total resection of choroid plexus tumors in the fourth ventricle is difficult because of invasion into the fourth ventricle floor. Adjuvant therapy for choroid plexus tumors with brain stem infiltration must be established.     

Clinical, histological, and genetic features of fourth ventricle ependymoma in the elderly

A 71-year-old woman presented with a rare case of geriatric ependymoma originating from the fourth ventricle manifesting as progressive gait and memory disturbance. Imaging studies revealed an extraaxial mass in the fourth ventricle protruding into the right cerebellomedullary cistern, with concomitant obstructive hydrocephalus. Surgery achieved subtotal removal since the tumor tightly adhered to the right vestibular area of the fourth ventricular floor. The histological diagnosis was ependymoma, which was also confirmed by comparative genetic hybridization. Although she developed severe laryngeal edema and worsening of the hydrocephalus postoperatively which required additional treatment, she recovered with residual mild gait disturbance, and was transferred to a rehabilitation facility. Fourth ventricle ependymoma in the elderly is rare. Comparative genetic hybridization may be important in the diagnosis of geriatric ependymoma and in the choice for adjuvant therapy as well as in estimating the prognosis for patients with rare types of ependymoma.     

Fourth ventricle central neurocytoma: case report

OBJECTIVE AND IMPORTANCE: Central neurocytomas (CNs) are typically located in the lateral ventricle. Primary origins in the fourth ventricle are very rare. We discuss the clinical symptoms, imaging findings, and microscopic features of these rare tumors. CLINICAL PRESENTATION: We report a case of a fourth ventricle CN in a 35-year-old male patient with the initial symptoms of progressive headaches and blurred vision for more than 2 months. Computed tomography and magnetic resonance imaging of the brain revealed a slightly enhanced tumor in the fourth ventricle, with obstructive hydrocephalus. INTERVENTION: Total surgical removal of the tumor was performed. The tumor was initially diagnosed as an oligodendroglioma. The final definitive diagnosis as a CN was made after special immunohistochemical studies. CONCLUSION: CNs located in the fourth ventricle are extremely rare. Immunohistochemical stains and transmission electron microscopy can provide useful diagnostic information. Total tumor excision is associated with favorable prognoses. Postoperative radiotherapy may be considered for cases of subtotal excision, anaplastic histological variants, or recurrent tumors.     

复发性颅咽管瘤的手术治疗

目的　探讨复发性颅咽管瘤的手术治疗方法。方法　回顾性分析 4 0例复发性颅咽管瘤患者的临床资料。其中男 2 4例 ,女 16例 ,平均年龄 35 1岁。主要临床表现 :视力减退 2 5例 ,头痛9例 ,视野缺损 2例 ,闭经 2例 ,性欲减退 1例 ,多饮多尿 1例。平均复发时间 2 9年。 32例为手术后肿瘤残留复发 ,8例为手术肿瘤全切除后复发。肿瘤位于鞍上 19例 ,鞍上 鞍下 9例 ,鞍下 5例 ,第三脑室者 7例。囊性肿瘤 2 1例 ,实性 19例。钙化者 2 7例 ,其中大块样钙化 ( >2cm)者 5例。有脑积水者 12例。手术采用翼点入路 33例 ,额下入路 5例 ,纵裂经胼胝体入路 2例。结果　经翼点入路 33例中 ,2 2例全切除 ,近全切除 9例 ,大部切除 2例。额下入路 5例 ,4例全切除 ,1例近全切除。纵裂胼胝体前部入路 2例中 1例肿瘤全切除 ,1例近全切除。术中垂体柄保留 8例 ,术中断裂 9例 ,术中未见垂体柄 2 3例。术后多饮多尿 17例 ,下丘脑功能低下 12例 ,术后 35d因下丘脑功能低下死亡 1例。随访 3个月～ 3年 ,2 2例患者正常生活和工作 ,11例患者可做轻工作或生活自理 ,6例患者生活需要照顾。结论　虽然复发性颅咽管瘤与周围下丘脑结构有不同程度的粘连 ,但是多数复发性颅咽管瘤患者手术治疗仍可达到良好的效果     

Epidermoid cysts of the fourth ventricle

The location of epidermoid cysts within the fourth ventricle is rare. The Authors present three cases operated on. The most frequent symptom was ataxia. Increased intracranial pressure and hydrocephalus were rare even when the tumors were large in size and filled up the fourth ventricle. Neuroradiological data are presented. Surgical removal was generally easy though the tumor invaded the cisterns and a true peritumoral capsule was found only in the lower part of the ventricular floor. The bursting of the cyst followed by continuous production of keratin with subsequent invasion of cisterns and foramina is suggested as a possible mechanism to explain the tumoral growing.     

110例颅咽管瘤手术经验

目的 探讨手术全切除颅咽管瘤的有效方法。方法 110例颅咽管瘤患者,男性62例,女性58例。年龄15．0－67．0岁,平均34．4岁。其中102例患者取翼点入路,5例经额下入 路,3例经纵裂从胼胝体至穹窿间隙和第三脑室前部切除肿瘤。术中根据肿瘤位置,从视交叉前间隙、视神经外侧间隙和颈内动脉外侧间隙切除肿瘤。术中注意保护下丘脑神经结构和防止穿通动脉的 损伤。结果 101例患者达到肿瘤全切除,6例次全切除,3例大部切除。术中垂体柄保留57例,断裂29例,未见垂体柄24例。术后54例患者有多饮多尿,52例3个月内恢复,2例持续1年以上;52例患者有血钠紊乱,均在3个月内恢复;3例术后视力减退加重;3例动眼神经麻痹,其中1例1年以上仍无恢复,2例暂短性肢体瘫;4例死亡。术后随访1个月－5．0年,平均1．1年。101例肿瘤全切除患者,有4例复发。本组患者术后99例能参加日常工作,5例生活自理,2例需要生活照顾。结论 选择合适的手术入路,保护下丘脑结构和功能,是颅咽管瘤全切除并获得良好效果的关键。     

Dorsally exophytic brain stem tumors: total removal of a medullary pilocytic astrocytoma in child. Clinicopathological considerations and case report

The authors describe the case of 4-year-old girl who was operated on for a pilocytic astrocytoma of the brain stem, exophytic and protruded backward into the fourth ventricle. The removal through a suboccipital midline approach was performed and macroscopically complete. Postoperative complications compelled a heavy reanimation with a prolonged follow-up therapy. The neurological recovery was favorable. Three years later, this little girl is almost autonomous in all daily activities. Postoperative scans showed total tumor resection. The patient received no complementary treatment such as radiotherapy, chemotherapy or corticotherapy. The long-term survival, without the need for adjunctive therapy, confirms the good prognosis for this unusual group of brain stem tumors. The clinicopathological and radiological features are described and surgical questions are discussed especially regarding complete or subtotal removal of brain stem tumors in demarcated-benign astrocytomas.     

Fourth ventricle rosette-forming glioneuronal tumor. Case report

The authors describe a rosette-forming glioneuronal tumor of the fourth ventricle in a 29-year-old woman. She had been experiencing dizziness for 1 year and headaches for 1 month. Cranial computed tomography revealed a relatively circumscribed mass involving the inferior cerebellum and floor of the fourth ventricle with extension into the ventricle. Histologically, much of the tumor was piloid with Rosenthal fibers as well as telangiectatic blood vessels; other areas contained complete or incomplete neurocytic rosettes. This tumor type must be differentiated from pilocytic astrocytomas, other gliomas with a piloid glial component, and glioneuronal tumors arising from the floor of the fourth ventricle or inferior cerebellum. Recognition of, and long-term follow up for, this recently described pathological entity may clarify the nature of this lesion and strategies for its optimal management.