Yue He, Ling Wang, Yibo Ou, Sheng Wang, Sicheng Tang, Jincao Chen, Dongsheng Guo
Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China.
Department of Operating room, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China.
Childs Nerv Syst. 2018 Sep;34(9):1619-1626. doi: 10.1007/s00381-018-3869-8. Epub 2018 Jun 23.
This report detailed four cases of tumor recurrence in the subfrontal region after cerebellar medulloblastoma resection without local relapse and explored the causes of recurrence. In addition, a case-based update and insight into the entity is attempted.
All four patients received cerebellar medulloblastoma resection and postoperative radiotherapy. They were admitted to our hospital when they were found to have a recurrent tumor in the subfrontal region of the anterior skull base. All four patients received re-resection of the tumor, which was confirmed to be recurrent medulloblastoma by postoperative pathological results.
All patients received local radiotherapy and temozolomide chemotherapy after recurrent tumor resection. They all died due to multiple organ failure resulting from tumor metastasis to other sites or tumor regrowth within 2 years after the second operation.
Medulloblastoma metastasize to the subfrontal region and develop a homogenous recurrence is rare. Underdosage of radiation, a gravity-related sanctuary effect, surgical position, and perioperative hydrocephalus management might be factors contributing to this supratentorial meningeal recurrence. A better prevention of tumor recurrence might be achieved by extensive microsurgical tumor resection in the initial operation and by minimizing the need for a permanent V-P shunt in the treatment of perioperative hydrocephalus as well as by administering full-dose radiotherapy to the region of the cribriform plate in the subfrontal area.
本报告详细介绍了4例小脑髓母细胞瘤切除术后无局部复发但额下区域出现肿瘤复发的病例，并探讨了复发原因。此外，还尝试基于病例对该疾病进行更新和深入分析。
所有4例患者均接受了小脑髓母细胞瘤切除术及术后放疗。当发现他们在前颅底额下区域出现复发性肿瘤时，被收治入我院。所有4例患者均接受了肿瘤再次切除术，术后病理结果证实为复发性髓母细胞瘤。
所有患者在复发性肿瘤切除术后均接受了局部放疗和替莫唑胺化疗。他们均在第二次手术后2年内因肿瘤转移至其他部位或肿瘤再次生长导致多器官功能衰竭而死亡。
髓母细胞瘤转移至额下区域并发生同源性复发较为罕见。放疗剂量不足、重力相关的庇护效应、手术位置以及围手术期脑积水管理可能是导致幕上脑膜复发的因素。通过在初次手术中广泛进行显微手术切除肿瘤、在围手术期脑积水治疗中尽量减少永久性脑室-腹腔分流术的需求以及对额下区域筛板部位给予全剂量放疗，可能会更好地预防肿瘤复发。
