He Minglian, Zhong Jun, Li Xuegang, Chen Yujie, Li Fei
Department of Neurosurgery and State Key Laboratory of Trauma, Burn and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China; Chongqing Clinical Research Center for Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China; Chongqing Key Laboratory of Precision Neuromedicine and Neuroregenaration, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China.
Department of Neurosurgery and State Key Laboratory of Trauma, Burn and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China; Chongqing Clinical Research Center for Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China; Chongqing Key Laboratory of Precision Neuromedicine and Neuroregenaration, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China.
Int J Surg Case Rep. 2022 Aug;97:107440. doi: 10.1016/j.ijscr.2022.107440. Epub 2022 Jul 21.
Primary central nervous system lymphoma (PCNSL) is a rare cranial malignant haematological tumour. PCNSL in the cerebellar region is less common than PCNSL in other encephalic regions. A diagnosis of cerebellar PCNSL is relatively difficult to make due to its diverse imaging manifestations. The aim of this case series report is to determine whether surgery could be used to confirm the diagnosis of cerebellar PCNSL and the effect of surgical treatment.
We report 3 cases of cerebellar PCNSL that underwent neuronavigation microsurgery under general anaesthesia. The operation was performed by author 3 and author 5. One patient underwent left lateral ventricular drainage on the fourth and tenth days after the operation due to postoperative obstructive hydrocephalus. All patients received chemotherapy or radiotherapy after histological confirmation.
All patients' tumours were completely removed. One patient developed obstructive hydrocephalus twice during the perioperative period after the operation, was given drainage, and then recovered from the hospital. The other two patients recovered and were discharged smoothly without complications. One patient died 9 months after the operation, and the other two patients survived. The prognosis of 3 patients was related to tumour size and timely follow-up chemo-radiation therapy.
The histology of all patients showed diffuse large B-cell lymphoma (GCB phenotype). Suspicious cerebellar PCNSL patients should undergo surgery to confirm the diagnosis, followed by radiotherapy and chemotherapy.
原发性中枢神经系统淋巴瘤（PCNSL）是一种罕见的颅内恶性血液肿瘤。小脑区域的PCNSL比其他脑区的PCNSL少见。由于其多样的影像学表现，小脑PCNSL的诊断相对困难。本病例系列报告的目的是确定手术是否可用于确诊小脑PCNSL以及手术治疗的效果。
我们报告3例小脑PCNSL患者，均在全身麻醉下接受神经导航显微手术。手术由作者3和作者5实施。1例患者术后第4天和第10天因术后梗阻性脑积水接受了左侧脑室引流。所有患者在组织学确诊后均接受了化疗或放疗。
所有患者的肿瘤均被完全切除。1例患者术后围手术期发生两次梗阻性脑积水，经引流后康复出院。另外两名患者康复顺利，无并发症出院。1例患者术后9个月死亡，另外两名患者存活。3例患者的预后与肿瘤大小及及时的后续放化疗有关。
所有患者的组织学检查均显示弥漫性大B细胞淋巴瘤（GCB表型）。疑似小脑PCNSL的患者应接受手术以确诊，随后进行放疗和化疗。
