Gi H, Yoshizumi H, Nagao S, Nishioka T, Uno J, Fujita Y
Department of Neurosurgery, Osaka Red Cross Hospital.
No Shinkei Geka. 1990 Nov;18(11):1041-5.
The patient, a 39-year-old man, underwent initial surgery for total removal of a left C-P angle tumor histologically diagnosed as epidermoid carcinoma. Postoperative irradiation therapy was administered over the whole brain and spinal cord, 50 Gy and 20 Gy respectively. The patient was then released without symptoms. 15 months later, he was readmitted for paraparesis and urinary retention. CT scan revealed no tumor recurrence in the intracranial area but did show intraspinal cyst of the lower thoracic level. After cyst-subarachnoid shunt, severe acute hydrocephalus was shown on CT scan. His general condition progressively deteriorated. Ten days after the shunt operation, he died of systemic bleeding tendency and cachexia. During surgery, the authors obtained dark yellowish fluid from the intraspinal cyst. Gene survey of the specimen from the cyst wall disclosed abnormality. It is important in the diagnosis of primary intracranial epidermoid carcinoma that we rule out the existence of extracranial cancer and direct invasion through the dura. Though epidermoid carcinoma can be fatal, radiotherapy was an efficacious treatment in the present case, as well as in three other reported cases.
患者为一名39岁男性，因组织学诊断为表皮样癌的左侧桥小脑角肿瘤接受了全切手术。术后分别对全脑和脊髓进行了放疗，剂量分别为50 Gy和20 Gy。患者随后无症状出院。15个月后，因双下肢轻瘫和尿潴留再次入院。CT扫描显示颅内区域无肿瘤复发，但显示下胸段脊髓内囊肿。在进行囊肿 - 蛛网膜下腔分流术后，CT扫描显示严重的急性脑积水。他的一般状况逐渐恶化。分流手术后十天，他死于全身出血倾向和恶病质。手术过程中，作者从脊髓囊肿中获取了暗黄色液体。对囊肿壁标本的基因检测发现异常。在原发性颅内表皮样癌的诊断中，排除颅外癌症的存在以及通过硬脑膜的直接侵犯很重要。尽管表皮样癌可能致命，但放疗在本病例以及其他三例报告病例中都是一种有效的治疗方法。
