Operative resection of the fourth ventricular tumors in children

    HE Xiaoª²Sheng, ZHANG Xiang, FEI Zhou, LIU Weiª²Ping, FU Luoª²an, ZHANG Jianª²Ning, LI Xia

    PLA Institute of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi¡¯an 710033, China

    ¡¾Abstract¡¿ AIM: To explore the diagnosis and treatment of fourth ventricular tumors in children. METHODS: Thirtyª²two children suffering from fourth ventricular tumors were admitted to our hospital and underwent removal of tumor by midline suboccipital approach under microscope. The pathological characteristics, clinical manifestations, image changes, surgical operation, and prognosis were summarized and analyzed. RESULTS: Total removal was achieved in 28 cases, and subtotal removal in 4 cases. The postoperative pathological examination showed medulloblastoma in 18 cases, ependymoma in 10, choroids plexus papilloma in 1, teratoma in 1, astrocytoma in 1, and dermoid cyst in 1 case. There was no death in this group. During the period of hospitalization, 22 cases showed syndrome of lower intracranial pressure such as headache and vomiting, 17 cases manifested refractory hiccup. These symptoms disappeared by antiª²symptomatic therapy. Twentyª²three cases received reª²examination with head CT, among which 13 revealed hydrocephalus. In the 22 cases who were followed up, 16 lived with a normal life and study moods (among which 8 underwent Xª²knife or ¦Ãª²knife therapies, and 6 received cerebroª²ventrivular shunting operations), 5 children (who all lacked postª²operational radiotherapies) demonstrated progressive symptomatic worsening and their CT or MRI examination verified the recurrence of the original tumor (among which 3 underwent ¦Ãª²knife therapies, another two received reª²operation). CONCLUSION: Medulloblastoma accounts for the main part of the fourth ventricular tumors in children while the second commonlyª²seen tumor is ependymoma. Early diagnosis, total resection, and postoperational radiotherapy are very important in prevention of the recurrence of these kinds of tumors. ......