Antunes Cristiano, Ramos Rui, Machado Maria João, Filipe Miguel Afonso
Neurosurgery, Hospital de Braga, Braga, Portugal.
BMJ Case Rep. 2019 Mar 20;12(3):e228454. doi: 10.1136/bcr-2018-228454.
Posterior fossa lesions may present with behavioural changes and/or progressive neurological deficit. Patients may have symptoms for long periods which may be attributed to other causes such as psychiatric diseases. We report a case of a 44-year-old woman with behavioural changes lasting for 5 years who lost her job, marriage and the guard of her sons. Latterly, she developed neurological deficit, hydrocephalus and intracranial hypertension. A giant left pontocerebellar angle mass was diagnosed. A retrosigmoid craniotomy was performed with total removal and cranial nerve function's preservation. Histology revealed a grade I meningioma. The surgical approach for such huge lesions on pontocerebellar angle is controversial concerning patient's positioning and surgical route. A brief revision is made. Since nowadays medical imaging is more easily accessible, it is mandatory to have a brain image in patients with behavioural changes and/or neurological deficit to exclude potential structural and curable causes such as in this case.
后颅窝病变可能表现为行为改变和/或进行性神经功能缺损。患者可能长期出现症状，这些症状可能归因于其他原因，如精神疾病。我们报告一例44岁女性，其行为改变持续5年，导致失业、婚姻破裂并失去对儿子的监护权。后来，她出现了神经功能缺损、脑积水和颅内高压。诊断为左侧桥小脑角巨大肿物。行乙状窦后开颅术，实现全切除并保留了颅神经功能。组织学检查显示为I级脑膜瘤。对于桥小脑角如此巨大的病变，手术入路在患者体位和手术路径方面存在争议。本文进行简要回顾。由于如今医学影像更容易获取，对于有行为改变和/或神经功能缺损的患者，必须进行脑部影像检查，以排除潜在的结构性和可治愈病因，如此病例所示。
