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一名12岁儿童的恶性播散性脊索样脑膜瘤:次全切除术后早期颅脑和脊髓放射治疗的作用

Malignant disseminated chordoid meningioma in a 12-year-old child: a role for early cranial and spinal radiation treatment after subtotal resection.

作者信息

Mullassery Dhanya, O'Brien Donncha F, Williams Dawn, Crooks Daniel, Mallucci Conor, Pizer Barry, Thorp Nicky, McDowell Heather

机构信息

Department of Neurosurgery, Neuropathology and Neuro-oncology, Royal Liverpool Children's Hospital NHS Trust, Alder Hey, Liverpool, UK.

出版信息

Childs Nerv Syst. 2006 Oct;22(10):1344-50. doi: 10.1007/s00381-006-0096-5. Epub 2006 Apr 11.

Abstract

CASE REPORT

We present a case of a chordoid meningioma, a tumour sub-type which comprises less than 0.5% of all meningiomas. The patient, a 12-year-old Somalian girl with a history of having had a craniotomy for a brain tumour in her native country 11 months previously, presented with seizures. Imaging revealed an isolated left frontal tumour, which at the time was felt to be a residual mass. She underwent a macroscopically complete resection of this tumour. Histology revealed it to be a grade 2 chordoid meningioma. Recurrence with additional local meningeal lesions was detected on follow-up magnetic resonance imaging (MRI) at 2 months post surgery. These were resected and she was treated with adjuvant cranial radiation treatment that resulted in non-progression of the cranial tumour on imaging 6 and 12 months post surgery. However, at 12 months post initial presentation, she re-presented with disseminated spinal disease refractory to salvage radiation treatment and succumbed to her illness.

OUTCOME

This is the first reported case of cranial radiation treatment being used to treat sub-totally resected recurrent chordoid meningioma. Whilst intra-cranial control of the tumour was achieved with this management, it did not prevent spinal progression. The authors advise a high-surveillance management strategy when treating these lesions and to employ cranial and spinal radiation treatment at the first sign of disease progression.

摘要

病例报告

我们报告一例脊索样脑膜瘤病例,该肿瘤亚型在所有脑膜瘤中占比不到0.5%。患者为一名12岁的索马里女孩,11个月前在其祖国因脑肿瘤接受过开颅手术,此次因癫痫发作前来就诊。影像学检查发现一个孤立的左侧额叶肿瘤,当时认为是残留肿块。她接受了该肿瘤的大体完整切除。组织学检查显示为2级脊索样脑膜瘤。术后2个月的随访磁共振成像(MRI)检查发现肿瘤复发并伴有额外的局部脑膜病变。这些病变被切除,她接受了辅助性颅脑放射治疗,术后6个月和12个月的影像学检查显示颅脑肿瘤无进展。然而,在初次就诊12个月后,她再次出现播散性脊髓疾病,对挽救性放射治疗无效,最终因病去世。

结果

这是首例报道使用颅脑放射治疗来治疗次全切除的复发性脊索样脑膜瘤的病例。虽然通过这种治疗方法实现了颅内肿瘤的控制,但并未能阻止脊髓病变进展。作者建议在治疗这些病变时采用高监测管理策略,并在疾病进展的首个迹象出现时采用颅脑和脊髓放射治疗。

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