Clinical Aspects and Prognosis of Intracranial Tumors in Children

本文收集自1969年至1978年10年間在臺大醫院住院的小兒顱內腫瘤共87例。這些病人均經過開刀、活體切片或屍體解剖而知道其組織變化，其中58例是男孩，29例是女孩。年齡以15歲、12歲及7歲為最多。腫瘤病例並無逐年增加的趨勢。臨床病史有77%是在六個月以下。入院時最主要的症狀是顱內壓上升引起的頭痛(83.9%)和嘔吐(75.9%)。視神經乳頭水腫則是最常見的神經學徵候，其次為反射亢進或出現病態反射。腫瘤位置以上顱內腔最多，共53例，下顱內腔腫瘤有34例。病理學上，這些腫瘤以星狀細胞瘤(astrocytoma)最多，共31例，次為神經管胚細胞瘤（medulloblastoma, 16例）;多形細胞膠母細胞瘤（glioblastoma multiforme, 8例）；顱咽瘤（craniopharyngioma, 7例）；松果腺瘤（pinealoma, 7例）及管室膜瘤（ependymoma, 4例）。實驗室檢查方面，頭部X光片最常見的是顱內壓上升所引起的變化，亦卽骨縫分開或出現指狀紋（46例）。有11例可見顱內鈣化。接受腦波檢查者有71例，其中29例出現局部性高位徐波，20例出現兩側間歇性徐波。腦波對大腦半球腫瘤較具診斷價值。有54例接受腦部同位素掃描，其中45例出現放射線核子之局部積聚。腦血管攝影共施行67例，以血管移位最為常見（33例）。腦充氣X光攝影或腦室攝影最常見的變化是腦室移位、變形及局部性腦室擴大(10例）。此種腦充氣檢查對後腦部位腫瘤最具診斷價值。此87例病人中，5例來不及開刀卽去世，餘82例接受開腦移除腫瘤手術或脊髓液分流手術。有15例失去追蹤檢查，餘下病人中，17例於手術後1個月內死亡，手術死亡率為21%。其餘50例病人中，僅28例到目前仍然存活。

關鍵字

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並列摘要

A total of 87 children, aged less than 15 years at the time of diagnosis as intracranial tumor were reviewed. There were 58 boys and 29 girls. The duration of clinical history was less than 6 months in 77% of the children. The most important symptoms leading to admission and diagnosis were due to raised intracranial pressure: headache occurred in 83.9 per cent, and vomiting in 75.9 per cent of cases. Papilledema was one of the commonest signs on admission, which was followed by hyper-reflexia and/or pathological reflexes. Tumors were located in the supratentorial space in 53 and in the infratentorial space in 34 cases. Histologically they were distributed as follows: astrocytoma (35.6%), medulloblastoma (18.4%), glioblastoma multiforme (9.2%), craniopharyngioma (8.1%), pinealoma (8.1%) and ependymoma (4.6%). Fifteen patients (17.2%) were lost to this. follow-up study. The outcomes of these children were not very good After a follow-up period of 1 to 11 years, 38.9 per cent of the-patients were found to be alive. Patients who had a longer clinical history, and a tumor in the supratentorial space, or with the histological type of astrocytoma or craniopharyngioma, had a better prognosis.

並列關鍵字

intracranial tumor ； supratentorial tumor ； infratentorial tumor

國際替代計量

Clinical Aspects and Prognosis of Intracranial Tumors in Children

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