Glenn Chad A, Fung Kar-Ming, Tullos Hurtis J, McNall-Knapp Rene Y, Gunda Divya, Mapstone Timothy B
Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
World Neurosurg. 2016 Feb;86:514.e13-8. doi: 10.1016/j.wneu.2015.08.077. Epub 2015 Sep 4.
Chronic subdural hematoma in the pediatric population often results from trauma. Asymptomatic and benign-appearing subdural collections are generally managed conservatively without operative intervention. Primary intracranial sarcomas are uncommon entities. Diagnosis of sarcoma can be difficult because these lesions often manifest as apparent hematoma.
Presented is the case of a primary intracranial mucoid spindle cell sarcoma that arose in a child with a history of benign-appearing bilateral subdural fluid collections in the setting of nonaccidental trauma. The patient was initially managed conservatively because her neurological examination result was normal and her subdural collections decreased in size on repeated imaging. The collections did not resolve completely. Years later, she exhibited weakness, seizure, and an increase in the size of her subdural fluid collection. Subdural drainage was attempted without significant effect. Cytologic assessment of fluid was negative for malignant cells. Magnetic resonance imaging revealed multiple enhancing masses along the subdural collection. The patient eventually underwent craniotomy in which a diagnosis of sarcoma was obtained. Pathological and radiographic findings as well as oncological management are reviewed. The authors also review the natural history and treatment of primary intracranial sarcoma in the pediatric population.
Early contrasted magnetic resonance imaging should be obtained in patients with subdural fluid collections that appear asymmetric or do not resolve in the expected time course, despite having a normal neurologic examination result. Negative cytologic assessment does not exclude sarcoma diagnosis.
儿科人群中的慢性硬膜下血肿通常由创伤引起。无症状且外观良性的硬膜下积液一般采用保守治疗，无需手术干预。原发性颅内肉瘤是罕见的疾病。肉瘤的诊断可能很困难，因为这些病变常表现为明显的血肿。
本文介绍了一例原发性颅内黏液样梭形细胞肉瘤病例，该病例发生在一名有非意外创伤史且曾出现双侧外观良性硬膜下积液的儿童身上。患者最初接受保守治疗，因为其神经系统检查结果正常，且重复影像学检查显示硬膜下积液体积减小。积液并未完全消退。数年后，她出现了虚弱、癫痫发作，硬膜下积液体积增大。尝试进行硬膜下引流，但效果不显著。积液的细胞学评估未发现恶性细胞。磁共振成像显示沿硬膜下积液有多个强化肿块。患者最终接受了开颅手术，术中确诊为肉瘤。本文回顾了病理和影像学检查结果以及肿瘤治疗情况。作者还回顾了儿科人群原发性颅内肉瘤的自然病程和治疗方法。
对于硬膜下积液患者，即使神经系统检查结果正常，但如果积液不对称或未在预期时间内消退，应尽早进行增强磁共振成像检查。细胞学评估结果为阴性并不能排除肉瘤的诊断。
