Chung Lawrance K, Beckett Joel S, Ong Vera, Lagman Carlito, Nagasawa Daniel T, Yang Isaac, Kim Won
Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, USA.
Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, USA; Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California, USA; Department of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, California, USA; Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, California, USA.
World Neurosurg. 2017 Sep;105:689-696. doi: 10.1016/j.wneu.2017.06.037. Epub 2017 Jun 12.
To present an illustrative case of fourth ventricular epidermoid cyst and review the literature to identify predictors of surgical outcomes.
A case of fourth ventricular epidermoid cyst is presented and a systematic review of 5 popular databases was performed by independent authors. Stepwise logistic regression was performed to identify clinical predictors of outcomes.
A 21-year-old woman presented with 3 months of headaches and visual obscurations and was diagnosed with a multilobulated mass in the fourth ventricle. The patient underwent suboccipital craniotomy. Complete removal of the mass was achieved and the final diagnosis was consistent with an epidermoid cyst. The systematic review identified 23 studies that reported 37 patients. Mean age was 42.8 years. Mean length of time between symptom onset and diagnosis was 4.43 years. Age (P = 0.049) and duration of symptoms (P < 0.001) were significantly different between patients who experienced symptom improvement and those who did not. Duration of symptom onset to diagnosis was a significant predictor of poor outcomes (odds ratio, 1.19, 95% confidence interval, 1.003-4.785).
Our review found that in patients with fourth ventricular epidermoid cysts, unfavorable outcomes were predicted by older age and by longer intervals from symptom onset to diagnosis. Clinicians should maintain a high index of suspicion for fourth ventricular epidermoid cysts in patients presenting with cerebellar signs and visual disturbances.
介绍一例第四脑室表皮样囊肿病例，并回顾文献以确定手术结果的预测因素。
报告一例第四脑室表皮样囊肿病例，并由独立作者对5个常用数据库进行系统综述。采用逐步逻辑回归分析确定结果的临床预测因素。
一名21岁女性出现3个月的头痛和视力模糊症状，被诊断为第四脑室内有一个分叶状肿块。患者接受了枕下开颅手术。肿块被完全切除，最终诊断为表皮样囊肿。系统综述确定了23项研究，共报告了37例患者。平均年龄为42.8岁。症状出现至诊断的平均时间为4.43年。症状改善患者与未改善患者之间的年龄（P = 0.049）和症状持续时间（P < 0.001）存在显著差异。症状出现至诊断的持续时间是预后不良的重要预测因素（优势比，1.19，95%置信区间，1.003 - 4.785）。
我们的综述发现，对于第四脑室表皮样囊肿患者，年龄较大以及症状出现至诊断的间隔时间较长预示着不良预后。临床医生对于出现小脑体征和视觉障碍的患者应高度怀疑第四脑室表皮样囊肿。
