Zhang Hong, Qing Bing, Zheng Jian
Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
World Neurosurg. 2018 Sep;117:190-194. doi: 10.1016/j.wneu.2018.06.078. Epub 2018 Jun 20.
Gastroparesis following resection of a fourth ventricle tumor has never been reported in the literature. We report a unique case of gastroparesis following resection of a fourth-ventricle ependymoma in a child.
A 14-year-old boy had a 12-day history of headache, nausea, and vomiting. Magnetic resonance imaging revealed a tumor in the fourth ventricle. He underwent a posterior median craniotomy, and total removal was achieved. Histologic analysis revealed an anaplastic ependymoma (World Health Organization grade III). Three days after surgery, the patient complained of upper abdominal pain, nausea, and vomiting. Computed tomography of the abdomen showed dilatation of the stomach. Gastroscopy revealed moderate gastritis without gastric outlet obstruction. Nine days after surgery, a jejunal feeding tube (J-tube) was placed for nutritional support. Once the patient improved his oral intake and demonstrated that he could keep up with his nutritional requirements, the J-tube was discontinued 19 days after surgery. The patient had no neurologic or gastrointestinal complaints at the 2-month follow up.
We report, to our knowledge, the first case of gastroparesis following resection of a fourth-ventricle ependymoma in a child. Gastroparesis can recover spontaneously, which we suspect may be due to reversible injury of the dorsal motor nucleus of the vagus.
文献中从未报道过第四脑室肿瘤切除术后发生胃轻瘫的情况。我们报告了一例儿童第四脑室室管膜瘤切除术后发生胃轻瘫的独特病例。
一名14岁男孩有12天的头痛、恶心和呕吐病史。磁共振成像显示第四脑室内有一个肿瘤。他接受了后正中开颅手术，并实现了肿瘤全切。组织学分析显示为间变性室管膜瘤（世界卫生组织III级）。术后三天，患者主诉上腹部疼痛、恶心和呕吐。腹部计算机断层扫描显示胃扩张。胃镜检查显示中度胃炎，无胃出口梗阻。术后九天，放置了空肠喂养管（J管）以提供营养支持。一旦患者改善了经口摄入量，并证明能够满足其营养需求，J管在术后19天停用。在2个月的随访中，患者无神经或胃肠道不适主诉。
据我们所知，我们报告了首例儿童第四脑室室管膜瘤切除术后发生胃轻瘫的病例。胃轻瘫可自发恢复，我们怀疑这可能是由于迷走神经背核的可逆性损伤所致。
