Tancredi A, Fiume D, Gazzeri G
Department of Neurosurgery, S. Filippo Neri Hospital, Rome, Italy.
Acta Neurochir (Wien). 2003 Oct;145(10):905-10; discussion 910-1. doi: 10.1007/s00701-003-0008-3.
This study reports late surgical results obtained in 9 patients operated on for an epidermoid cyst of the fourth ventricle. They represent 19/9% of all cases of epidermoids treated at our Department over a period of 25 years (1975-2000). 7 cases were diagnosed with CT and 2 cases with MR. Duration of clinical history ranged from 2 months to 6 years (mean: 2,2 years). Preoperatively, 2 cases presented spontaneous remission of neurological symptoms and signs lasting about 1 year. 7 (77,8%) patients underwent subtotal removal of the cyst whereas in 2 patients the lesion was totally excised. 3 patients (33,3%) underwent a second operation for symptomatic recurrence diagnosed between 10 and 17 years from the first operation. At present, 7 (77,8%) patients are alive (mean follow up of 14,5 years, ranging from 5 to 23 years) without neuroradiological and clinical evidence of tumour recurrence. In this group, 6 have no neurological problems and 1 suffers from a light vestibulo-cerebellar syndrome. Fourth ventricle epidermoids have a good long-term prognosis even in the case of only subtotal removal. Follow-up clinical and MR controls allow an earlier diagnosis of recurrence. Surgery of recurrent cysts can be more demanding; nonetheless, long term prognosis can be quite good for patients in well preserved neurological condition.
本研究报告了9例因第四脑室表皮样囊肿接受手术治疗的患者的晚期手术结果。他们占我们科室在25年（1975 - 2000年）期间治疗的所有表皮样囊肿病例的19/9%。7例通过CT诊断，2例通过MR诊断。临床病史持续时间从2个月到6年不等（平均：2.2年）。术前，2例患者出现神经症状和体征的自发缓解，持续约1年。7例（77.8%）患者接受了囊肿次全切除，而2例患者的病变被完全切除。3例患者（33.3%）在首次手术后10至17年因症状复发接受了二次手术。目前，7例（77.8%）患者存活（平均随访14.5年，范围从5年到23年），没有肿瘤复发的神经放射学和临床证据。在这组患者中，6例没有神经问题，1例患有轻度前庭 - 小脑综合征。即使仅进行次全切除，第四脑室表皮样囊肿也有良好的长期预后。随访的临床和MR检查有助于早期诊断复发。复发性囊肿的手术可能要求更高；尽管如此，对于神经状况良好的患者，长期预后可能相当不错。
