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題名 | Pilocytic Astrocytoma of the Posterior Fossa: A Follow-Up Study in 15 Patients=後顱窩毛狀星細胞瘤:15位病人的追蹤治療經驗 |
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作者姓名(中文) | 潘宏川; 黃棣棟; 郭萬祐; 李良雄; | 書刊名 | 中華醫學雜誌 |
卷期 | 62:5 1999.05[民88.05] |
頁次 | 頁278-284 |
分類號 | 416.291 |
關鍵詞 | 神經系統影像學檢查技術; 小兒腦瘤; 毛狀星細胞瘤; 後顱窩; Magnetic resonance imaging; Pediatric brain tumor; Pilocytic astrocytoma; Posterior fossa; |
語文 | 英文(English) |
中文摘要 | 背景:後顱窩毛狀星細胞瘤是一良性的腦瘤,然而對此腦瘤的切除範圍並無明 顯的界定。若此病同時併有水腦,其處理方式也未有統一的結論。我們藉著一系列手術後 磁振造影檢查來評估手術施行的根除性,同時也探討病人併有水腦的治療方式。 方法:從1986-1996年間,共有15例接受根除性丰術的後顱窩毛狀星細胞瘤病人,其中14 例接受長期的磁振造影追蹤檢查。追蹤的時間為術後1個月,之後每半年追蹤1次為期2年 ,往後則為每年1次。 結果:14位病人接受長期追蹤,追蹤時間從11-119個月不等(平均41.5個月)。病人年齡 介於2-13歲之間,平均年齡則為7±3歲。此14位病人皆接受根除性的手術,其中12位的手 術預後良好,無神經功能缺損;2位術後有神經功能缺損但能獨立生活。此外,4位病人於 術後的磁振造影檢查有持續不正常的顯影;然而只有1位病人的持續不正常的顯影有增大 的情形。手術後的影像追蹤發現11位併有水腦的病人中,6位只接受腫瘤摘除術,5位接受 腫瘤摘除術及腦室外引流,只有1位病人需接受永久性的腦室腹腔分流管手術。 結論:我們的研究發現,後顱窩毛狀星細胞瘤的切除範圍可以一系列術後的磁振造影檢查 來評估。對於顯示有不正常顯影的病人更需要長期磁振造影的追蹤檢查。永久性的分流管 手術只適用於術後持續存在水腦的病人。 |
英文摘要 | Background. The extent of resection in pilocytic astrocytoma of the posterior fossa remains undefined, as the problem of hydrocephalus has not yet been solved. We retrospectively reviewed the data from 15 patients with a pilocytic astrocytoma of the posterior fossa to evaluate the impact of surgical technique, in terms of resection extent, by serial magnetic resonance imaging (MRI) examinations. In addition, the issue of hydrocephalus was considered and related to the different treatment modalities. Methods. Macroscopic, gross, total resection of the tumor was performed in all 15 patients. Follow-up was obtained in 14 patients for a period ranging between 11 and 119 months (median, 41.5 months). The ages of patients ranged from two to 13 years (mean, 7 ±3 years). All patients underwent serial MRI examinations in the first month, every six months for the first two years and then yearly. Results. Outcome was good in 12 patients who had no neurologic deficit and fair in two patients who were slightly handicapped but had an independent life. There were four patients with an abnormally persistent enhancement on MRI, with a median follow-up of 30 months. One of these patients had progressively increasing size of the enhancement. Three of them had the same size of enhancement during the follow-up period. The MRI findings showed residual tumors in four patients. One of them had tumor regrowth one year after surgery. There were 11 cases with pilocytic astrocytoma and hydrocephalus. Five patients were treated with tumor removal and external CSF drainage. Six patients underwent tumor removal only, without perioperative cerebrospinal fluid (CSF) drainage. Only one patient had a permanent ventriculoperitoneal shunt. Conclusions. Our study illustrated that the extent of tumor resection of pilocytic astrocytoma can be defined by postoperative serial MRI examinations. Long-term follow-up with MRI seems mandatory in cases with abnormal enhancement. Hydrocephalus is a common finding in patients with a pilocytic astrocytoma. A permanent ventriculoperitoneal shunt is required only in patients with postoperative hydrocephalus. lus. |
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