Due-Tønnessen Bernt Johan, Helseth Eirik
Department of Neurosurgery, Rikshospitalet-Radiumhospitalet Medical Center, Oslo, Norway.
Pediatr Neurosurg. 2007;43(2):92-6. doi: 10.1159/000098379.
The majority of children with posterior fossa tumors have hydrocephalus (HC) at the time of presentation. There is no consensus regarding the management of HC in these children. Here, we report the rate of cure of HC with tumor surgery alone.
This is a retrospective study of 87 children with posterior fossa tumors in which 35 patients had medulloblastoma, 38 had astrocytoma and 14 had ependymoma. The mean age at presentation was 7.3 years (range: 0.2-19.7 years). All patients underwent tumor resection and were followed with close clinical and image surveillance to detect persistent HC. HC was treated with endoscopic third ventriculostomy (ETV) or shunt. We have focused on patients who needed permanent cerebrospinal fluid diversion (ETV or shunt) within 30 days of tumor resection. HC presenting after this time period is, in the majority of cases, due to tumor recurrence or progression. In this series, 24/87 (28%) patients had a suboccipital craniectomy and 63/87 (72%) had a craniotomy.
At the time of presentation, 69/87 (79%) patients had symptomatic HC. In 41/69 (59%) patients presenting with HC, the HC was cured by tumor resection alone. The HC cure rate for patients with astrocytoma was 83%, whereas it was 47% for patients with medulloblastoma and 54% for patients with ependymoma. The cure rate was equal in the craniectomy and craniotomy groups.
An 87% cure rate of HC by tumor resection alone in children with posterior fossa astrocytoma warrants no change in treatment strategy. However, the low cure rate of HC by tumor resection alone in patients with medulloblastoma and ependymoma raises the issue of whether these patients would benefit from preresection ETV.
大多数后颅窝肿瘤患儿在就诊时患有脑积水（HC）。对于这些患儿中脑积水的管理尚无共识。在此，我们报告仅通过肿瘤手术治愈脑积水的比例。
这是一项对87例后颅窝肿瘤患儿的回顾性研究，其中35例患有髓母细胞瘤，38例患有星形细胞瘤，14例患有室管膜瘤。就诊时的平均年龄为7.3岁（范围：0.2 - 19.7岁）。所有患者均接受了肿瘤切除术，并通过密切的临床和影像监测进行随访以检测持续性脑积水。脑积水采用内镜下第三脑室造瘘术（ETV）或分流术治疗。我们重点关注了在肿瘤切除术后30天内需要永久性脑脊液分流（ETV或分流术）的患者。在此时间段之后出现的脑积水，在大多数情况下，是由于肿瘤复发或进展所致。在本系列研究中，2 / 87（28%）例患者接受了枕下颅骨切除术，63 / 87（72%）例患者接受了开颅手术。
就诊时，69 / 87（79%）例患者有症状性脑积水。在41 / 69（59%）例患有脑积水的患者中，脑积水仅通过肿瘤切除术得以治愈。星形细胞瘤患者的脑积水治愈率为83%，而髓母细胞瘤患者为47%，室管膜瘤患者为54%。颅骨切除术组和开颅手术组的治愈率相同。
对于后颅窝星形细胞瘤患儿，仅通过肿瘤切除术治愈脑积水的比例达87%，这表明治疗策略无需改变。然而，髓母细胞瘤和室管膜瘤患者仅通过肿瘤切除术治愈脑积水的比例较低，这引发了这些患者是否会从术前ETV中获益的问题。
