Wang Mengmeng, Zhang Rende, Liu Xueyou, Li Dongming, Zhao Peichao, Zuo Yuchao, Zhang Peng, Wang Junkuan, Sun Hongwei
Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
World Neurosurg. 2018 Apr;112:e772-e777. doi: 10.1016/j.wneu.2018.01.153. Epub 2018 Jan 31.
Cortical ependymomas (CEs), supratentorial ependymomas that selectively involve the cerebral cortex, are relatively rare neoplasms that have not been extensively described. The purpose of our study was to identify the clinical features, radiologic characteristics, and treatment of a series of such tumors.
Thirteen patients with CEs from our hospital were included in this study. Epidemiologic characteristics, clinical features, imaging findings, treatment methods, and clinical outcomes were reviewed retrospectively.
The patients consisted of 7 men and 6 women with mean age of 31.1 ± 23.2 years (range, 4-74 years). The most common clinical manifestation was seizure (n = 11; 85%), followed by headache (n = 2; 15%). None of the tumors were incidentally detected. Eight CEs were located in the right hemisphere and 5 in the left side. The 2 most common tumor locations were the frontal (n = 5; 38%) and parietal lobe (n = 5; 38%). All patients underwent surgical resection. Gross total resection was achieved in 12 patients (92%), and subtotal resection was performed in 1 patient (8%). Ten of the 11 patients who presented with seizure are seizure-free after surgery (91% seizure-free rate). According to the World Health Organization classification system, 9 tumors (69%) were Grade II (ependymoma) and 4 (31%) were Grade III (anaplastic ependymoma). The mean follow-up was 52 months (range, 20-88 months). No recurrence was observed in patients with Grade II CEs. Of 4 patients with Grade III CEs, 2 (50%) suffered from tumor recurrence after initial treatment.
CEs are a rare subset of supratentorial ependymomas that selectively involve the cerebral cortex. Most CEs are low grade and present with seizures. Anaplastic CEs show a greater recurrence rate and a relatively poor prognosis. Gross total resection with or without adjuvant radiotherapy is currently the optimal treatment for CEs. CEs seem to have a more favorable prognosis than other supratentorial ependymomas.
皮质室管膜瘤（CEs）是一种选择性累及大脑皮质的幕上室管膜瘤，是相对罕见的肿瘤，目前尚未得到广泛描述。本研究的目的是确定一系列此类肿瘤的临床特征、影像学特点及治疗方法。
本研究纳入了我院13例皮质室管膜瘤患者。回顾性分析其流行病学特征、临床特征、影像学表现、治疗方法及临床结局。
患者包括7名男性和6名女性，平均年龄31.1±23.2岁（范围4 - 74岁）。最常见的临床表现为癫痫发作（n = 11；85%），其次是头痛（n = 2；15%）。所有肿瘤均非偶然发现。8例皮质室管膜瘤位于右半球，5例位于左半球。最常见的两个肿瘤部位是额叶（n = 5；38%）和顶叶（n = 5；38%）。所有患者均接受了手术切除。12例患者（92%）实现了全切，1例患者（8%）进行了次全切。11例有癫痫发作的患者中，10例术后无癫痫发作（无癫痫发作率为91%）。根据世界卫生组织分类系统，9例肿瘤（69%）为Ⅱ级（室管膜瘤），4例（31%）为Ⅲ级（间变性室管膜瘤）。平均随访时间为52个月（范围20 - 88个月）。Ⅱ级皮质室管膜瘤患者未观察到复发。4例Ⅲ级皮质室管膜瘤患者中，2例（50%）在初始治疗后出现肿瘤复发。
皮质室管膜瘤是幕上室管膜瘤中选择性累及大脑皮质的罕见亚型。大多数皮质室管膜瘤为低级别，表现为癫痫发作。间变性皮质室管膜瘤复发率更高，预后相对较差。目前，全切或不全切加辅助放疗是皮质室管膜瘤的最佳治疗方法。皮质室管膜瘤的预后似乎比其他幕上室管膜瘤更有利。
