以腫瘤出血為表現的中心性腦神經細胞瘤

以腫瘤出血為表現的中心性腦神經細胞瘤

黃亮瑋(Liang-Wei Huang) ； 劉安正(Ann-Jeng Liu) ； 黃錚暉(Cheng-Hui Huang) ； 林慶揚(Ching-Yang Lin) ； 高木榮(Mu-Jung Kao) ； 張至文(Chih-Wen Chang) ； 白玟娟(Wen-Chuan Pai) ； 蕭勝煌(Sheng-Huang Hsiao)

《中華民國癌症醫學會雜誌》 25卷1期 (2009/02) Pp. 71-77

https://doi.org/10.6588/JCOS.2009.25.1.10

摘要

中心性腦神經細胞瘤是一種少見的中樞神經系統的腦室內腫瘤，它大約佔了所有腦瘤的0.25至0.5%。在臨床症狀上多數表現和阻塞性水腦導致的腦壓上升有關，以出血表現造成患者急性症狀的中心性腦神經細胞瘤更是罕見。
本篇報告一例29歲男性，出現急性的頭痛與嘔吐，而後伴隨有意識不清送至醫院求診，經頭部電腦斷層發現於右側腦室有一異質性的病灶，位在孟絡氏洞至腦室中間三分之一處，並伴隨有鈣化與腦室內出血。以頭部磁振造影檢查，在T1加權影像下，為等訊號強度的質塊，伴隨有部分區域呈現高訊號強度，注射顯影劑後，病灶實質為輕度顯影。在T2加權影像下，可見病灶實質大部分呈現高訊號強度，而部分區域則呈現低訊號強度。在腦瘤伴隨出血的初步診斷下，以手術由右側以經皮質經腦室的方式切除腫瘤，並於術後接受復健治療。病理報告吻合術前診斷為中心性腦神經細胞瘤。經追蹤一年後沒有復發，日常生活功能也恢復至完全獨立，並能從事全職工作。中心性腦神經細胞瘤伴隨腦室內出血在成人的顱內腫瘤相當少見，但仍需要列入鑑別診斷。本研究回顧這類病例的診斷與治療方式，以作為臨床參考。

關鍵字

中心性腦神經細胞瘤 ； 腦室內出血 ； 手術治療

並列摘要

Central neurocytoma is a rare intraventricular tumor of the central nervous system comprising 0.25 to 0.5% of all brain tumors. Most of its clinical symptoms are related to increased intracranial pressure resulting from obstructive hydrocephalus. A central neurocytoma presenting with acute symptoms from sudden intratumoral hemorrhage is even rarer.
A 29-year-old male experienced acute onset of headache and vomiting, followed by loss of consciousness, and was admitted to an area hospital. Computed tomography showed a right intraventricular heterogeneous lesion, with calcification and intraventricular hemorrhage, extending from the Foramen of Monro to the middle third of the ventricular body. Magnetic resonance T1-weighted images revealed an isointense mass with some foci of bright signal intensity. After contrast injection, the mass became mildly enhanced. Magnetic resonance T2-weighted images revealed bright signal intensity of this mass with some foci of low signal intensity within the mass. Under the impression of brain tumor with intratumoral hemorrhage, craniotomy and tumor excision were done via a right transcortical transventricular approach. Pathology showed a central neurocytoma. The patient was followed-up at the outpatient department for one year and no recurrence was noted. He resumed his daily activities and returned to full-time employment. Central neurocytoma is a rare hemorrhagic brain tumor in adults. The diagnosis and treatment of this disease are discussed.

並列關鍵字

central neurocytoma ； intraventricular hemorrhage ； surgery