頁籤選單縮合
題 名 | 臺灣的腦腫瘤(257例的臨床報告)=Clinical Observation on 257 Cases of Brain Tumors in Taiwan |
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編 次 | 下 |
作 者 | 施純仁; | 書刊名 | 中華民國外科醫學會雜誌 |
卷 期 | 1:2 民57.06 |
頁 次 | 頁90-101 |
關鍵詞 | |
語 文 | 中文(Chinese) |
英文摘要 | In Addition to the 74 consecutive case of intracrnial tumors experienced from 1951 to 1960, which we had reported in Chinese Medical Journal, June, 1962, 183 more cases of intracranial tumors were encountered in the hospitals related to National Defense Medical Center in the past 7 years, making a total of 257 cases of intacranial tumors experienced from January, 1951 to December, 1967, inclusive. Among 257 cases of intracranial tumors there were 210 males and 47 females, 241 were proved histologically, including 97 gliomas and 144 other intracranial tumors. Of 241 histologically verified intracranial tumors, 174 were situated supratenorially and 67 infratentorially, 55 cases occurred in children under 15 years of age. (22.8% of all intracranial tumors occurred in children.) Among 55 intracranial tumors of children 27 were supratentorial tumors and 28 infratentorial. All but one tuberculoma of 28 infratelltorial tumors in children were gliomas, including 11 medulloblastomas, 5 astrocytomas, 4 ependymomas (4th ventricle), 4 glioblastomas, 2 oligodendrogliomas, and one pinealoma. The ratio of medullo-blastoma vs. astrocytoma in the posterior fossa in children seems to be reversed in our series in comparison with that which appeared in the western literatures. 27 of supratentorial tumors in children included 7 gliomas, 13 craniopharyngioma, 2 pituitary adenomas (chromophobe), one sarcoma and one hemangioma. Among 186 cases of histologically verified intracranial tumors in the patients over 15 years of age, 63 were gliomas and 123 other tumors, the ratio being 1: 2. While the supra-and infratentorial tumors were about same in number among the children, the number of supratentorial tumors as compared with the infratentorial ones were remarkablly high among the patients over 15 years of age regardless the nature of the tumors. The incidence of ependymoma among all the intracranial tumors seems to be conrsiderablly high in the presnt scries in comparison with the incidence of the same tumor reported in the various western literatures. The incidence of pinealoma, which was reportedly high in Japan, is not much different in our series from that appeared in the series reported in the States and Europe. Present series included 6 cases of cerebral paragonimiasis, of which 5 were encountered in the 10 years period from 1951 to 1960 while only one was experienced in the past 7 years from 1961 to 1967. The last case occurred in the right parietal lobe of a 22-year-old soldier with marked caleification of the granuloma demonstrable in plain roentgenograms of skull and clinical history of severe headache and focal cerebral seizures. The granuloma was found to have invaded the wall of the laterul ventricle and was successfully exstirpated without significant residual neurological deficits. In this report some clinical aspects as well as the results of operative treatment in each group of the intracranial tumors were also discussed briefly. 211 of 257 patients were treated surgically and 51 cases died within one month after the operation with overall mortality of 24.3%. There were 18 operative deaths among 56 cases operated on in the 10 years period from 1951 to 1960 with operative mortality of 32.1%, the mortality of the glioma group being 48% and the mortality of other intracranial tumors 19.6% respectively. Among 155 cases operated in the past 7 years (1961-1967) there were 33 operative deaths with mortality of 21.2%, the mortality of the glioma group being 24.6% and other intracranial tumors 18.8%. There has been significant reduction of operative mortality in the patients suffering from gliomas whereas thers has been only minimal reduction of operative mortality in the patients operated on for removal of intracranial tumors other than gliomas. The use of corticosteroid as well as hypertonic solutions such as urea, mannitol and glycerol has apparently played an important role in the inprovement of the operative mortality especially among the cases with gliomas besides the more proper selection of the operative cases by means of improved diagnostic methods iucluding the cerebral angiogram, radioisotope scanning and iodoventriculogram. Iodoventriculogram has proved to be most useful for the diagnosis of tumors arisen in the posterior cranial fossa. Although the mortality rate of intracranial tumors other than gliomas in our series showed no significant improvement in the past 7 years as compared with the foregoing 10 years period, more patients operated on for removal of this group of tumors in the past 7 years have been enjoying usefull lives with little loss of function than those openated on before. Training of more neurosurgeons seems to be imperative in view of the fact that there are rapidly increasing number of patients with intracranial tumors in the past few years seeking for neurosurgical treatmet in this island. |
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