Posterior fossa ependymoma comprises two distinct molecular entities,ependymoma_posterior fossa A(EPN_PFA)and ependymoma_posterior fossa B(EPN_PFB),with differentiable gene expression profiles.As yet,the response of t...Posterior fossa ependymoma comprises two distinct molecular entities,ependymoma_posterior fossa A(EPN_PFA)and ependymoma_posterior fossa B(EPN_PFB),with differentiable gene expression profiles.As yet,the response of the two entities to treatment is unclear.To determine the relationship between the two molecular subgroups of posterior fossa ependymoma and treatment,we studied a cohort of 820 patients with molecularly profiled,clinically annotated posterior fossa ependymomas.We found that the strongest predictor of poor outcome in patients with posterior fossa ependymoma across the entire age spectrum was molecular subgroup EPN_PFA,which was recently reported in the paper entitled "Therapeutic impact of cytoreductive surgery and irradiation of posterior fossa ependymoma in the molecular era:a retrospective multicohort analysis" in the Journal ofClinical Oncology.Patients with incompletely resected EPN_PFA tumors had a very poor outcome despite receiving adjuvant radiation therapy,whereas a substantial proportion of patients with EPN_PFB tumors can be cured with surgery alone.展开更多
Objective and Methods: A case of Ondine’s curse after posterior fossa decompression was reported. A 33-year-old woman was admitted complaining 2 years of dizziness and progressive worsening of gait disturbances, and ...Objective and Methods: A case of Ondine’s curse after posterior fossa decompression was reported. A 33-year-old woman was admitted complaining 2 years of dizziness and progressive worsening of gait disturbances, and 1 year of repetitively ictal nausea. The diagnosis of Arnold-Chiari malformations was established. Results: The patient underwent suboccipital craniectomy and C1-3 laminectomy. In addition to this decompression measure, a fascial graft was sutured between the edges of the dural incision. Postoperatively, the patient lost automatic control of her respiration doting sleep and became hypercapnic and hypoxemic. Assisted ventilation was initiated. Conclusion: Ondine’s curse is possibly due to insensitivity of central chemoreceptors to carbon dioxide resulting in defective control of minute ventilation. Propofol is not recommended in eases of Ondine’s curse, and assisted ventilation until the restoration of automatic control of respiration can be of value. Oxygen inspiration alone is rather harmful than beneficial.展开更多
PURPOSE:To review the efficacy and patterns of failure in average-risk medulloblastoma patients treated withconcurrent chemotherapy and reduced-dose cranial spinal irradiation and a conformal tumor bed boost.METH-ODS ...PURPOSE:To review the efficacy and patterns of failure in average-risk medulloblastoma patients treated withconcurrent chemotherapy and reduced-dose cranial spinal irradiation and a conformal tumor bed boost.METH-ODS AND MATERIALS:Thirty-three patients with average risk(defined as<==1.5 cm(2)of residual tumorafter resection,age>3 years,and no involvement of the cerebrospinal fluid or spine)medulloblastoma werediagnosed at our institution between January 1994 and December 2001.They were enrolled in an institutional展开更多
BACKGROUND We described a case of a patient with a meningioma in the posterior fossa presenting atypically with an isolated unilateral vocal cord palsy causing severe respiratory distress.This is of interest as the pa...BACKGROUND We described a case of a patient with a meningioma in the posterior fossa presenting atypically with an isolated unilateral vocal cord palsy causing severe respiratory distress.This is of interest as the patient had no other symptomatology,especially given the size of the mass,which would typically cause a pressure effect leading to neurological and auditory symptoms.CASE SUMMARY This case report described a 48-year-old male who was married with two children and employed as a car guard.He had a medical history of asthma for the past 10 years controlled with an as-needed beta 2 agonist metered dose inhaler.He initially presented to our facility with severe respiratory distress.He reported a 1-wk history of shortness of breath and wheezing that was not relieved by his bronchodilator.He had no constitutional symptoms or impairment of hearing.On clinical examination,the patient’s chest was“silent.”Our initial assessment was status asthmaticus with type 2 respiratory failure,based on the history of asthma,a“silent chest,”and the arterial blood gas results.CONCLUSION A posterior fossa meningioma of such a large size and with extensive infiltration rarely presents with an isolated unilateral vocal cord palsy.The patient’s chief presenting feature was severe respiratory distress,which combined with his background medical history of asthma,was misleading.Clinicians should thus consider meningioma as a differential diagnosis for a unilateral vocal cord palsy even without audiology involvement.展开更多
Introduction: teratomas are non-malignantgerm cell tumors commonly composed of cell types derived from all of the three germ layers. Intracerebral teratomas typically are midline or paraxial lesions located in the pit...Introduction: teratomas are non-malignantgerm cell tumors commonly composed of cell types derived from all of the three germ layers. Intracerebral teratomas typically are midline or paraxial lesions located in the pituitary stalk or the pineal region. We report our experience with mature teratomas of the posterior fossa. Case report: we present the case of an 11-year-old caucasian female with progressive headache that caused interrupted sleep. Cerebral magnetic resonance imaging showed a midline lesion in the posterior fossa with mass effect and without contrast enhancement. Anatomic pathology revealed a mature teratoma. Conclusion: differential diagnosis of midline lesions in pediatric patients must include teratomas in spite of being posterior fossa lesions.展开更多
Ischemic damage produced in the posterior cerebral territory causes significant morbidity and urgently must be considered if the patient need a surgical attitude. Surgical decompression by suboccipital craniectomy sea...Ischemic damage produced in the posterior cerebral territory causes significant morbidity and urgently must be considered if the patient need a surgical attitude. Surgical decompression by suboccipital craniectomy seams to be effective to treat secondary edema due to cerebellar damage or in posterior fossa, when medical treatment is not able to control side effects. We report a clinical case of a patient with a subacute ischemic infarction in the vertebro-basilar territory, with perilesional edema, and a posterior fossa decompressive craniectomy (DC) was carried out.展开更多
Objective: Aim of the study was to assess the duration of preoperative external ventricular drain (EVD) as a predictor for permanent cerebrospinal fluid (CSF) diversion in pediatric posterior fossa tumors. Methods: Th...Objective: Aim of the study was to assess the duration of preoperative external ventricular drain (EVD) as a predictor for permanent cerebrospinal fluid (CSF) diversion in pediatric posterior fossa tumors. Methods: The study was conducted in the Department of Pediatric Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia from January 2010 to December 2013. The data were collected retrospectively. The patients who had emergency insertion of external ventricular drain (EVD) due to hydrocephalus before the definitive posterior fossa tumor surgery were included in the study. Results: The preoperative emergency insertion of EVD was done in 38 patients with pediatric posterior fossa tumors. The patients were divided into two groups. Group A consists of those patients who had duration of preoperative EVD equal or less than 7 days. Group B includes those patients who had duration of preoperative EVD more than 7 days. Group A has 16 patients while Group B has 22 patients. The predominant clinical feature was symptoms and signs of raised intracranial pressure (ICP) only. Infection related to EVD was seen in seven patients. Ventriculoperitoneal (VP) shunt was required in 31.25% of Group A patients and 18.18% of Group B patients (p value = 0.35). Overall shunt rate was 23.68%. Conclusion: There are well known number of factors that can determine the need of permanent CSF diversion in patients with posterior fossa tumors. However, there is no effect of preoperative duration of EVD in determining the requirement of postoperative VP shunt.展开更多
Objective To elucidate the diagnosis and surgical treatment of the posterior fossa solid hemangio^blastomas (PFSHs) Methods The data from 22 patients with PFSHs verified by surgery and pathology were analyzed retro...Objective To elucidate the diagnosis and surgical treatment of the posterior fossa solid hemangio^blastomas (PFSHs) Methods The data from 22 patients with PFSHs verified by surgery and pathology were analyzed retrospectively and a review of relevant literature was conducted Results The preoperative definitive diagnosis rate was 13/22 Total tumor removal was achieved in 20 patients Two of the 22 patients died after surgery, one of brain stem injury and the other from an intracranial hemorrhage Twenty patients were followed up for 2 months to 8 yeas (average, 2 years) Karnofsky scale was 80 in 15 patients, 60-70 in 1 patient and not measured in 4 patients who died during follow up The causes of death were pneumonia (2 patients) and purulent meningitis (2) Conclusion MRI and DSA (digital subtraction angiography) are major preoperative diagnostic modalities for PFSH, but PFSH remains a challenging benign neoplasm Special microsurgical techniques and improved operative manipulation can improve surgical efficacy展开更多
Purpose： Posterior fossa epidural hematomas （PFEDH） are uncommon in children but usually require timely surgical intervention due to the risk of life-threatening brainstem compression. We attempt to make the surgic...Purpose： Posterior fossa epidural hematomas （PFEDH） are uncommon in children but usually require timely surgical intervention due to the risk of life-threatening brainstem compression. We attempt to make the surgical procedure less invasive by treating selected pediatric patients with trephination minicraniectomy. Methods： We retrospectively reviewed the clinical courses, radiological findings, surgical procedures, and prognoses of the pediatric patients who were treated in our departments for traumatic PFEDH from January 2010 to January 2015. Results： During this period, a total of 17 patients were surgically treated for PFEDH and 7 were managed with trephination mini-craniectomy for hematoma evacuation. The outcomes were good in all 7 patients as evaluated with Glasgow Outcome Score. There was no mortality in this series. The on average 30-month clinical follow-up showed that patients experienced satisfactory recoveries without complications. Conclusion： Our results suggest that trephination mini-craniectomy is a safe surgical technique for selected PFEDH patients with moderate hematoma volume and stabilized neurological functions. However, standard craniectomy is recommend when there are rapid deteriorations in patients＇ neurological functions or the hematomas are large and exerted severe mass effects.展开更多
Objective To clarify the clinical features,therapeutic method and outcomes of the primary endodermal sinus tumors(ESTs)in the posterior cranial fossa.Methods The English literatures on EST in the posterior cranial fos...Objective To clarify the clinical features,therapeutic method and outcomes of the primary endodermal sinus tumors(ESTs)in the posterior cranial fossa.Methods The English literatures on EST in the posterior cranial fossa were retrieved from PubMed and reviewed.And a 4-year-old boy diagnosed with EST in our hospital was reported.The clinical manifestations,therapy,pathologic features,and prognosis of these cases were analyzed.Results Only seven cases of the ESTs in the posterior cranial fossa were enrolled in this review,including six cases searched from the PubMed and one case from our hospital.Six patients were boy and one patient’s gender was not available from the report.Ages ranged from 1 to 5 years(mean 3.14 years).The mean tumor size in our cohort was 4.4 cm.Six cases came from East Asia.Schiller-Duval bodies were found in all seven neoplasms.All tumors were positive for alpha-fetoprotein.The alpha-fetoprotein level in serum was increased to a very high level before therapy and depressed quickly after the effective chemotherapy.The mean follow-up time was 24.4 months(range 5-52 months).Six tumors were totally removed,and four of them recurred.Three cases died including one whose tumor was partially removed.Conclusions The serum alpha-fetoprotein level is well correlated with the severity of the tumor.A combination of operation and chemotherapy might be the effective management for EST in the posterior cranial fossa.The prognosis of extragonadal intracranial EST is poor.展开更多
OBJECTIVE To analyze and discuss about the clinicalcharacteristics, pathological types, surgical modalities andtechniques, and postoperative complications in children withtumor of posterior cranial fossa .METHODS Retr...OBJECTIVE To analyze and discuss about the clinicalcharacteristics, pathological types, surgical modalities andtechniques, and postoperative complications in children withtumor of posterior cranial fossa .METHODS Retrospective study was conducted on 102 cases ofpediatric tumor of posterior cranial fossa, admitted and treated inour hospital during the period of January 1996 to January 2007.All patients underwent microscopic surgical treatment. Fifty-eight were male and 44 cases were female. The age ranged from 9months to 14 years old, with an average of 6.1 ± 0.5 of age. CranialCT or MRI examination was conducted before and after thesurgery on all patients.RESULTS The primary manifestations for this group of patientswere increased intracranial pressure and/or ataxia. Postoperativepathological diagnoses showed: 46 cases of medulloblastoma, 43cases of astrocytoma, 11 cases of ependymoma (including 1 caseof degenerative ependymoma), 1 case of dermoid cyst, and 1 caseof teratoma. In this group of the patients, radical surgery wasused in 68 cases and subtotal surgical removal used in 31 cases,while surgical removal of large section was performed on 3 cases.There were no deaths from surgery reported. Ninety-one casesshowed significant symptomatic improvement when comparedwith preoperative conditions, while 11 cases showed either noimprovement or more severely affected afterward. For 6 cases,postoperative ventriculoperitoneal shunt was performed within7 days to 2 months after the surgery. Sixty-three patients gainedfollow-up for 3 to 60 months in duration. Thirty-nine patientsregained normal life and were able to learn well, while there were7 patients who could not live normally on their own. During thefollow-up period, there were 17 cases of recurrence and 7 casesof death. In 23 cases of medulloblastoma in children with age of3 years old or above, 2 cases who underwent surgical removal ofintracranial ependymoma received small dosage of postoperativeX-ray radiotherapy on the the brain and spinal cord. Nine casesof medulloblastoma in children under age of 3 and 17 cases ofastrocytoma diagnosed after the surgery received chemotherapyof Carmustine.CONCLUSION Medulloblastomas and astrocytomas werethe most common types of pediatric tumor of posterior cranialfossa, right followed by ependymoma, and dermoid cysts andteratomas were rare. Early correct diagnosis, proper selection ofappropriate surgical modality and the surgical margin, propertreatment of postoperative complications, and the selecting rightradiotherapy or chemotherapy were the key factors in influencingthe prognostic outcome of children with tumor of posterior cranialfossa.展开更多
Adult posterior fossa arachnoid cysts are rare lesions that are considered to be mostly congenital in origin. We present 49-year-old man admitted with a chief complaint of tremor and balance problems for the past 2 mo...Adult posterior fossa arachnoid cysts are rare lesions that are considered to be mostly congenital in origin. We present 49-year-old man admitted with a chief complaint of tremor and balance problems for the past 2 months. He had ataxia on examination. Magnetic resonance imaging revealed a well circumscribed midline cystic lesion of the posterior fossa sharing the same signal characteristics as cerebrospinal fluid and non-communicating to the fourth ventricle. He underwent surgical treatment for his symptomatic posterior fossa arachnoid cyst with a good outcome at 2 years follow up.展开更多
AIM:To discuss the value of technique of overlapped CT image in cerebral function of fossa cranii posterior.METHODS:27 cases of diseases of fossa cranii posterior were examined by three techenics(10 mm scan, 6 mm scan...AIM:To discuss the value of technique of overlapped CT image in cerebral function of fossa cranii posterior.METHODS:27 cases of diseases of fossa cranii posterior were examined by three techenics(10 mm scan, 6 mm scan, 3mm scan and overlapped image),and then compare the quality of image, accuracy rate of diagnoses, misdiagnosis rate between the three techniques.RESULTS:The quality of image of ovelaped image was better than the other.The accuracy rate of diagnosis were 77.8%, 85.2%and 96.3%.The false positive rate were 14.8%,11.1%and 3.7%.The false negtive rates were 7.4%,3.7%and 0.CONCLUSION:There was important value for diagnosis of diseases of fossa cranii posterior with technique of overlapped CT image,and can provide help for estimation of the cerebral function.展开更多
文摘Posterior fossa ependymoma comprises two distinct molecular entities,ependymoma_posterior fossa A(EPN_PFA)and ependymoma_posterior fossa B(EPN_PFB),with differentiable gene expression profiles.As yet,the response of the two entities to treatment is unclear.To determine the relationship between the two molecular subgroups of posterior fossa ependymoma and treatment,we studied a cohort of 820 patients with molecularly profiled,clinically annotated posterior fossa ependymomas.We found that the strongest predictor of poor outcome in patients with posterior fossa ependymoma across the entire age spectrum was molecular subgroup EPN_PFA,which was recently reported in the paper entitled "Therapeutic impact of cytoreductive surgery and irradiation of posterior fossa ependymoma in the molecular era:a retrospective multicohort analysis" in the Journal ofClinical Oncology.Patients with incompletely resected EPN_PFA tumors had a very poor outcome despite receiving adjuvant radiation therapy,whereas a substantial proportion of patients with EPN_PFB tumors can be cured with surgery alone.
文摘Objective and Methods: A case of Ondine’s curse after posterior fossa decompression was reported. A 33-year-old woman was admitted complaining 2 years of dizziness and progressive worsening of gait disturbances, and 1 year of repetitively ictal nausea. The diagnosis of Arnold-Chiari malformations was established. Results: The patient underwent suboccipital craniectomy and C1-3 laminectomy. In addition to this decompression measure, a fascial graft was sutured between the edges of the dural incision. Postoperatively, the patient lost automatic control of her respiration doting sleep and became hypercapnic and hypoxemic. Assisted ventilation was initiated. Conclusion: Ondine’s curse is possibly due to insensitivity of central chemoreceptors to carbon dioxide resulting in defective control of minute ventilation. Propofol is not recommended in eases of Ondine’s curse, and assisted ventilation until the restoration of automatic control of respiration can be of value. Oxygen inspiration alone is rather harmful than beneficial.
文摘PURPOSE:To review the efficacy and patterns of failure in average-risk medulloblastoma patients treated withconcurrent chemotherapy and reduced-dose cranial spinal irradiation and a conformal tumor bed boost.METH-ODS AND MATERIALS:Thirty-three patients with average risk(defined as<==1.5 cm(2)of residual tumorafter resection,age>3 years,and no involvement of the cerebrospinal fluid or spine)medulloblastoma werediagnosed at our institution between January 1994 and December 2001.They were enrolled in an institutional
文摘BACKGROUND We described a case of a patient with a meningioma in the posterior fossa presenting atypically with an isolated unilateral vocal cord palsy causing severe respiratory distress.This is of interest as the patient had no other symptomatology,especially given the size of the mass,which would typically cause a pressure effect leading to neurological and auditory symptoms.CASE SUMMARY This case report described a 48-year-old male who was married with two children and employed as a car guard.He had a medical history of asthma for the past 10 years controlled with an as-needed beta 2 agonist metered dose inhaler.He initially presented to our facility with severe respiratory distress.He reported a 1-wk history of shortness of breath and wheezing that was not relieved by his bronchodilator.He had no constitutional symptoms or impairment of hearing.On clinical examination,the patient’s chest was“silent.”Our initial assessment was status asthmaticus with type 2 respiratory failure,based on the history of asthma,a“silent chest,”and the arterial blood gas results.CONCLUSION A posterior fossa meningioma of such a large size and with extensive infiltration rarely presents with an isolated unilateral vocal cord palsy.The patient’s chief presenting feature was severe respiratory distress,which combined with his background medical history of asthma,was misleading.Clinicians should thus consider meningioma as a differential diagnosis for a unilateral vocal cord palsy even without audiology involvement.
文摘Introduction: teratomas are non-malignantgerm cell tumors commonly composed of cell types derived from all of the three germ layers. Intracerebral teratomas typically are midline or paraxial lesions located in the pituitary stalk or the pineal region. We report our experience with mature teratomas of the posterior fossa. Case report: we present the case of an 11-year-old caucasian female with progressive headache that caused interrupted sleep. Cerebral magnetic resonance imaging showed a midline lesion in the posterior fossa with mass effect and without contrast enhancement. Anatomic pathology revealed a mature teratoma. Conclusion: differential diagnosis of midline lesions in pediatric patients must include teratomas in spite of being posterior fossa lesions.
文摘Ischemic damage produced in the posterior cerebral territory causes significant morbidity and urgently must be considered if the patient need a surgical attitude. Surgical decompression by suboccipital craniectomy seams to be effective to treat secondary edema due to cerebellar damage or in posterior fossa, when medical treatment is not able to control side effects. We report a clinical case of a patient with a subacute ischemic infarction in the vertebro-basilar territory, with perilesional edema, and a posterior fossa decompressive craniectomy (DC) was carried out.
文摘Objective: Aim of the study was to assess the duration of preoperative external ventricular drain (EVD) as a predictor for permanent cerebrospinal fluid (CSF) diversion in pediatric posterior fossa tumors. Methods: The study was conducted in the Department of Pediatric Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia from January 2010 to December 2013. The data were collected retrospectively. The patients who had emergency insertion of external ventricular drain (EVD) due to hydrocephalus before the definitive posterior fossa tumor surgery were included in the study. Results: The preoperative emergency insertion of EVD was done in 38 patients with pediatric posterior fossa tumors. The patients were divided into two groups. Group A consists of those patients who had duration of preoperative EVD equal or less than 7 days. Group B includes those patients who had duration of preoperative EVD more than 7 days. Group A has 16 patients while Group B has 22 patients. The predominant clinical feature was symptoms and signs of raised intracranial pressure (ICP) only. Infection related to EVD was seen in seven patients. Ventriculoperitoneal (VP) shunt was required in 31.25% of Group A patients and 18.18% of Group B patients (p value = 0.35). Overall shunt rate was 23.68%. Conclusion: There are well known number of factors that can determine the need of permanent CSF diversion in patients with posterior fossa tumors. However, there is no effect of preoperative duration of EVD in determining the requirement of postoperative VP shunt.
文摘Objective To elucidate the diagnosis and surgical treatment of the posterior fossa solid hemangio^blastomas (PFSHs) Methods The data from 22 patients with PFSHs verified by surgery and pathology were analyzed retrospectively and a review of relevant literature was conducted Results The preoperative definitive diagnosis rate was 13/22 Total tumor removal was achieved in 20 patients Two of the 22 patients died after surgery, one of brain stem injury and the other from an intracranial hemorrhage Twenty patients were followed up for 2 months to 8 yeas (average, 2 years) Karnofsky scale was 80 in 15 patients, 60-70 in 1 patient and not measured in 4 patients who died during follow up The causes of death were pneumonia (2 patients) and purulent meningitis (2) Conclusion MRI and DSA (digital subtraction angiography) are major preoperative diagnostic modalities for PFSH, but PFSH remains a challenging benign neoplasm Special microsurgical techniques and improved operative manipulation can improve surgical efficacy
文摘Purpose： Posterior fossa epidural hematomas （PFEDH） are uncommon in children but usually require timely surgical intervention due to the risk of life-threatening brainstem compression. We attempt to make the surgical procedure less invasive by treating selected pediatric patients with trephination minicraniectomy. Methods： We retrospectively reviewed the clinical courses, radiological findings, surgical procedures, and prognoses of the pediatric patients who were treated in our departments for traumatic PFEDH from January 2010 to January 2015. Results： During this period, a total of 17 patients were surgically treated for PFEDH and 7 were managed with trephination mini-craniectomy for hematoma evacuation. The outcomes were good in all 7 patients as evaluated with Glasgow Outcome Score. There was no mortality in this series. The on average 30-month clinical follow-up showed that patients experienced satisfactory recoveries without complications. Conclusion： Our results suggest that trephination mini-craniectomy is a safe surgical technique for selected PFEDH patients with moderate hematoma volume and stabilized neurological functions. However, standard craniectomy is recommend when there are rapid deteriorations in patients＇ neurological functions or the hematomas are large and exerted severe mass effects.
文摘Objective To clarify the clinical features,therapeutic method and outcomes of the primary endodermal sinus tumors(ESTs)in the posterior cranial fossa.Methods The English literatures on EST in the posterior cranial fossa were retrieved from PubMed and reviewed.And a 4-year-old boy diagnosed with EST in our hospital was reported.The clinical manifestations,therapy,pathologic features,and prognosis of these cases were analyzed.Results Only seven cases of the ESTs in the posterior cranial fossa were enrolled in this review,including six cases searched from the PubMed and one case from our hospital.Six patients were boy and one patient’s gender was not available from the report.Ages ranged from 1 to 5 years(mean 3.14 years).The mean tumor size in our cohort was 4.4 cm.Six cases came from East Asia.Schiller-Duval bodies were found in all seven neoplasms.All tumors were positive for alpha-fetoprotein.The alpha-fetoprotein level in serum was increased to a very high level before therapy and depressed quickly after the effective chemotherapy.The mean follow-up time was 24.4 months(range 5-52 months).Six tumors were totally removed,and four of them recurred.Three cases died including one whose tumor was partially removed.Conclusions The serum alpha-fetoprotein level is well correlated with the severity of the tumor.A combination of operation and chemotherapy might be the effective management for EST in the posterior cranial fossa.The prognosis of extragonadal intracranial EST is poor.
文摘OBJECTIVE To analyze and discuss about the clinicalcharacteristics, pathological types, surgical modalities andtechniques, and postoperative complications in children withtumor of posterior cranial fossa .METHODS Retrospective study was conducted on 102 cases ofpediatric tumor of posterior cranial fossa, admitted and treated inour hospital during the period of January 1996 to January 2007.All patients underwent microscopic surgical treatment. Fifty-eight were male and 44 cases were female. The age ranged from 9months to 14 years old, with an average of 6.1 ± 0.5 of age. CranialCT or MRI examination was conducted before and after thesurgery on all patients.RESULTS The primary manifestations for this group of patientswere increased intracranial pressure and/or ataxia. Postoperativepathological diagnoses showed: 46 cases of medulloblastoma, 43cases of astrocytoma, 11 cases of ependymoma (including 1 caseof degenerative ependymoma), 1 case of dermoid cyst, and 1 caseof teratoma. In this group of the patients, radical surgery wasused in 68 cases and subtotal surgical removal used in 31 cases,while surgical removal of large section was performed on 3 cases.There were no deaths from surgery reported. Ninety-one casesshowed significant symptomatic improvement when comparedwith preoperative conditions, while 11 cases showed either noimprovement or more severely affected afterward. For 6 cases,postoperative ventriculoperitoneal shunt was performed within7 days to 2 months after the surgery. Sixty-three patients gainedfollow-up for 3 to 60 months in duration. Thirty-nine patientsregained normal life and were able to learn well, while there were7 patients who could not live normally on their own. During thefollow-up period, there were 17 cases of recurrence and 7 casesof death. In 23 cases of medulloblastoma in children with age of3 years old or above, 2 cases who underwent surgical removal ofintracranial ependymoma received small dosage of postoperativeX-ray radiotherapy on the the brain and spinal cord. Nine casesof medulloblastoma in children under age of 3 and 17 cases ofastrocytoma diagnosed after the surgery received chemotherapyof Carmustine.CONCLUSION Medulloblastomas and astrocytomas werethe most common types of pediatric tumor of posterior cranialfossa, right followed by ependymoma, and dermoid cysts andteratomas were rare. Early correct diagnosis, proper selection ofappropriate surgical modality and the surgical margin, propertreatment of postoperative complications, and the selecting rightradiotherapy or chemotherapy were the key factors in influencingthe prognostic outcome of children with tumor of posterior cranialfossa.
文摘Adult posterior fossa arachnoid cysts are rare lesions that are considered to be mostly congenital in origin. We present 49-year-old man admitted with a chief complaint of tremor and balance problems for the past 2 months. He had ataxia on examination. Magnetic resonance imaging revealed a well circumscribed midline cystic lesion of the posterior fossa sharing the same signal characteristics as cerebrospinal fluid and non-communicating to the fourth ventricle. He underwent surgical treatment for his symptomatic posterior fossa arachnoid cyst with a good outcome at 2 years follow up.
文摘AIM:To discuss the value of technique of overlapped CT image in cerebral function of fossa cranii posterior.METHODS:27 cases of diseases of fossa cranii posterior were examined by three techenics(10 mm scan, 6 mm scan, 3mm scan and overlapped image),and then compare the quality of image, accuracy rate of diagnoses, misdiagnosis rate between the three techniques.RESULTS:The quality of image of ovelaped image was better than the other.The accuracy rate of diagnosis were 77.8%, 85.2%and 96.3%.The false positive rate were 14.8%,11.1%and 3.7%.The false negtive rates were 7.4%,3.7%and 0.CONCLUSION:There was important value for diagnosis of diseases of fossa cranii posterior with technique of overlapped CT image,and can provide help for estimation of the cerebral function.
