表现为发作性眼球运动异常和面肌痉挛的儿童第四脑室旁脑桥肿瘤的手术疗效观察  

Observation on surgical efficacy of pediatric pontine tumor adjacent to the fourth ventricle with paroxysmal ocular movement abnormalities and hemifacial spasm

作　　者：葛明[1] 蔡英杰 杨伟 凌苗 袁柳 孙骇浪[1] 冀园琦[1] 马文平 Ge Ming;Cai Yingjie;Yang Wei;Ling Miao;Yuan Liu;Sun Hailang;Ji Yuanqi;Ma Wenping(Department of Neurosurgery,Beijing Children′s Hospital Affiliated to Capital Medical University,National Center for Children′s Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院神经外科,北京100045

出　　处：《中华神经外科杂志》2024年第9期885-890,共6页Chinese Journal of Neurosurgery

基　　金：北京市医院管理中心临床医学发展专项(XMLX202144)。

摘　　要：目的探讨表现为发作性眼球运动异常和面肌痉挛的儿童第四脑室旁脑桥肿瘤的手术疗效及引起该症状的可能机制。方法回顾性分析2016年7月至2021年8月首都医科大学附属北京儿童医院神经外科收治的9例表现为发作性眼球运动异常和面肌痉挛的第四脑室旁脑桥肿瘤患儿的临床资料。7例患儿既往口服抗癫痫药物治疗,其中6例无效,1例发作频率下降50%。4例患儿术前的弥散张量成像显示肿瘤与外展神经核、面神经核关系密切。9例患儿均采用小脑延髓裂隙入路切除脑桥肿瘤。5例患儿术中行肿瘤深部电生理监测,记录肿瘤放电情况。于术后3、6、12个月及之后每年门诊随访患儿的临床症状,且至少每年复查1次头颅MRI。结果9例患儿均达到肿瘤全切除;其中8例组织病理学检查提示为节细胞胶质瘤[世界卫生组织(WHO)1级],1例为错构瘤。5例术中行神经电生理监测的患儿中,3例于肿瘤深部记录到1~3次棘波样放电,另2例患儿未记录到任何放电。术后,9例患儿的发作性症状均未再出现,均未使用抗癫痫药物。9例患儿的随访时间[M(范围)]为39(28~89)个月;至末次随访,未见肿瘤复发以及症状再发作;1例患儿术后出现右侧肢体肌力下降,左眼内斜,末次随访时患儿肌力恢复,但左眼内斜仍未恢复。结论表现为发作性眼球运动异常和面肌痉挛的第四脑室旁脑桥肿瘤患儿常规抗癫痫治疗无效,尽早行肿瘤全切除可达到临床治愈效果;其发作性症状可能与肿瘤的异常放电相关。Objective To investigate the pathogenesis,surgical treatment and prognosis of abnormal eye movement and hemifacial spasm secondary to pontine tumor close to the fourth ventricle in children.Methods A retrospective case series study was used to analyze the clinical data of 9 children with abnormal eye movement and hemifacial spasm secondary to periventicular pontine tumor admitted to the Department of Neurosurgery,Beijing Children′s Hospital Affiliated to Capital Medical University from July 2016 to August 2021.Seven children had previously been treated with oral antiepileptic drugs,with 6 showing no effect and 1 experiencing a 50%reduction in seizure frequency.Preoperative diffusion tensor imaging(DTI)in 4 children showed a close relationship between the tumor and the abducens nucleus and facial nucleus.All 9 cases were resected by cerebellar medullary fissure approach.Deep electroencephalogram monitoring was performed in 5 cases and tumor discharges were recorded.The outcome was evaluated by clinical and imaging follow-up at 3,6,12 months after surgery.Results Total tumor resection was achieved in all 9 cases.Among them,8 cases showed gangliomas(WHO grade 1)and 1 case was hamartoma.Among the 5 children,3 had 1 to 3 spike-like discharges recorded from the deep part of the tumor,while no discharges were recorded in the other 2 children.Postoperatively,all 9 children experienced an immediate cessation of seizure symptoms without the use of antiepileptic drugs.The follow-up time of 9 cases was 28-89 months(median:39 months),and no recurrence of tumor and recurrence of symptoms was found until the last follow-up.One case showed reduced muscle strength in right side and left eye inward strabismus.On the last follow-up,the muscle strength restored but the left eye remain inward strabismus.Conclusions Children with paraventricular pontine tumors who present with paroxysmal eye movement abnormalities and hemifacial spasm are ineffective in conventional anti-epileptic treatments.Early total tumor resection can achieve c

关 键 词：脑干肿瘤 儿童 第四脑室 眼球运动障碍 神经外科手术 

分 类 号：R739.41[医药卫生—肿瘤]