Valdés-Gorcía J, Espinoza-Díaz D M, Paredes-Díaz E
Departamento de Neurocirugía, Hospital Infantil de México Federico Gómez, México.
Acta Neurochir (Wien). 1998;140(9):899-903. doi: 10.1007/s007010050191.
Mass and cystic lesions of the posterior fossa constitute an important chapter in neurosurgical paediatric pathology. Their histological definition is essential for specific treatment. Different types of cysts, can be found besides gliomas, tuberculomas, vascular malformations, radionecrotic lesions or other masses. This paper summarises the results of an observational, descriptive, retrolective study of a group of 30 children with posterior fossa lesions seen from October 1989 to January 1997 at the Hospital Infantil de México (Children's Hospital of México). All the lesions were approached stereotactically to get biopsies and/or to drain cystic lesions. Clinical case notes were reviewed detailing different variables. It should be mentioned that in among these variables, all procedures were carried out using general endotracheal anaesthesia and that in spite of having performed the biopsy or drainage in the CT scanning suite, no infectious processes supervened. Tissue or fluid samples were obtained using the above mentioned procedure although the specimen was insufficient for histological diagnosis in one. For this case, a biopsy done afterwards by direct microsurgical exploration revealed an astrocytoma. In the rest, anaplastic astrocytomas were found in five patients, low grade astrocytomas in 11, and one case of each with the following lesions: medulloblastoma, reactive gliosis, germinoma, teratoma, tuberculoma, bacterial abscess, primitive neuro-ectodermal tumour and chronic leptomeningitis with a decreased cerebellar neuronal population. Two biopsies reported normal cerebellar tissue and in the remaining three, acellular fluid from cystic lesions was obtained. In four patients, cystic drainage was considered part of the treatment. Our results indicate that biopsies of masses and fluid drainage of cystic lesions of the posterior fossa are safe and simple methods. The empirical treatment that is sometimes used for these kinds of lesions, as well as for lesions at any other location in the central nervous system, should be abandoned.
后颅窝的肿块和囊性病变是小儿神经外科病理学中的重要内容。其组织学定义对特定治疗至关重要。除了胶质瘤、结核瘤、血管畸形、放射性坏死性病变或其他肿块外，还可发现不同类型的囊肿。本文总结了1989年10月至1997年1月在墨西哥儿童医院对30例后颅窝病变儿童进行的观察性、描述性、回顾性研究结果。所有病变均采用立体定向方法进行活检和/或引流囊性病变。回顾临床病例记录，详细记录不同变量。需要提及的是，在这些变量中，所有操作均在全身气管内麻醉下进行，尽管在CT扫描室进行了活检或引流，但未发生感染过程。使用上述方法获取组织或液体样本，尽管有一例样本不足以进行组织学诊断。对于该病例，随后通过直接显微手术探查进行的活检显示为星形细胞瘤。其余病例中，5例为间变性星形细胞瘤，11例为低级别星形细胞瘤，以下病变各1例：髓母细胞瘤、反应性胶质增生、生殖细胞瘤、畸胎瘤、结核瘤、细菌性脓肿、原始神经外胚层肿瘤和小脑神经元数量减少的慢性软脑膜炎。两次活检报告为正常小脑组织，其余三例获取了囊性病变的无细胞液体。4例患者的囊性引流被视为治疗的一部分。我们的结果表明，后颅窝肿块的活检和囊性病变的液体引流是安全且简单的方法。应摒弃有时用于这类病变以及中枢神经系统其他任何部位病变的经验性治疗方法。
