Meningiomas of the Lateral Ventricles

側腦室腦膜瘤：病例分析

洪尚祐(Shang-Yow Hung) ； 雷大雅(Tai-Ngar Lui) ； 張承能(Cheng-Nen Chang) ； 李石增(Shih-Tseng Lee)

《Formosan Journal of Surgery》 41卷3期 (2008/06) Pp. 86-92

https://doi.org/10.29833/FJS.200806.0002

摘要

側腦室腦膜瘤是一種少見的腫瘤。它起源於蜘蛛膜細胞在胚胎期內陷進入脈絡叢。腫瘤位於側腦室內緩慢生長，直到症狀出現，得以診斷時，腫瘤通常已經長的相當大。我們分析腦瘤資料庫，並回顧它的起源，臨床表現、影像特徵，與這種腫瘤的治療過程。這是屬於回溯性分析，自1976年1月至1996年12月，在林口長庚醫院，21年間共有4451位接受原發腦瘤手術患者。手術患者中，只有19例是側腦室腦膜瘤。其中17例位於三角區、2例位於前額葉角。15位是女性、4位是男性。術前的症狀以顱內壓升高為主，包括：頭痛74%、肢體無力47%、視力障礙42%、噁心嘔吐26%：初期症狀11%以精神障礙表現，大多數術前診斷可經由影像學檢查確定。
手術切除腫瘤的路徑中，12例使用後中顳葉切口、4例使用上頂枕葉切口、3例經胼胝體切口：其中有14例合併使用手術顯微鏡，3例使用手術中超音波定位。手術併發症包括：靜脈梗塞11%、泛發性血管內血液凝固症5%、傷口感染5%、和殘留腫瘤5%。術後有2例死亡、2例半癱，15例症狀改善。並未發現術後有腫瘤復發的情形。
總之，側腦室腦膜瘤是一種緩慢生長的腫瘤，常是因爲腫瘤相當大，產生腦壓升高的症狀才被發現。CT和MRI可以在早期準確診斷側腦室腦膜瘤。優勢半腦的手術路徑選擇需要特別小心，以避免重要功能喪失。我們建議使用顯微手術與術中超音波，特別注意保護引流靜脈，將會大幅降低死亡率與併發症，提高手術成功機會。

並列摘要

Objectives: Meningiomas of the lateral ventricles are rarely encountered tumors in the central nervous system. This is a retrospective study that illustrates different forms of presentation and modalities commonly applied to the treatment of lateral ventricular meningiomas.
Methods: Nineteen patients with meningiomas of the lateral ventricles underwent surgery at Chang Gung Memorial Hospital in Linkou between January 1976 and December 1996. The tumor was located in the trigone in 17 cases, and in the frontal horn in 2. All diagnoses were confirmed with operative findings and by histological examination. A retrospective analysis of the medical charts for clinical manifestations, radiological features, surgical interventions and surgical outcome was carried out.
Results: This study involved 15 female (79%) and four male patients (21%), ranging in age from 14 to 84 years (mean age 41.4 years) at the time of surgery. Preoperative symptoms included headache in 14 cases (74%), weakness in 9 cases (47%), visual disturbance in 8 cases (42%), nausea/vomiting in 5 cases (26%), seizures in 3 cases (16%), speech disturbance in 3 cases (16%), and mental disturbance in 2 cases (11%). Seventeen tumors (89%) were located in the trigone, and two tumors (11%) in the frontal horn. Twelve tumors (63%) were located in the left and 7 tumors (37%) in the right. Twelve tumors (63%) were treated by the posterior middle temporal approach; 4 tumors (21%) by the superior parieto-occipital approach; 2 tumors (11%) by the anterior transcallosal approach; and one tumor (5%) by the posterior transcallosal approach. Complications included venous infarct in 2 cases (11%); disseminated intravascular coagulation in one case (5%); wound infection in one case (5%), and residual tumor in one case (5%). On follow-up evaluation, 15 patients (79%) had a good outcome; 2 patients (11%) had a fair outcome, and two patients (11%) died.
Conclusions: The primary treatment for lateral ventricular meningioma is surgery, with the aim of total resection. Microsurgical removal of tumor probably contributed to the success in the treatment of the lateral ventricular meningiomas.

並列關鍵字

meningioma ； lateral ventricle ； surgical approach