高龄第四脑室原发性黑色素瘤1例  

A case of primary melanoma in the fourth ventricle in an elderly patient

作　　者：张义彪[1] 徐敬斌[1] 王鑫 常奎[1] 肖珂 高亚峰[1] ZHANG Yi-biao;XU Jing-bin;WANG Xin;CHANG Kui;XIAP Ke;GAO Ya-feng(Department of Neurosurgery,Fuyang Second People's Hospital,Fuyang 236015,China)

机构地区：[1]阜阳市第二人民医院神经外科,安徽236015

出　　处：《中国临床神经外科杂志》2024年第10期635-637,共3页Chinese Journal of Clinical Neurosurgery

摘　　要：颅内原发性黑色素瘤是一种罕见的神经外科疾病,可发生在颅内任何位置,但第四脑室内极其罕见。病人的预后因肿瘤分化程度、位置及切除范围不同而存在差异,因此,术前准确的诊断、术中尽可能完整切除肿瘤并辅以术后放疗是改善病人预后的关键。本文报道1例81岁病人,术前头颅CT及增强MRI检查均显示第四脑室肿瘤,完善术前准备后,在显微镜下完全切除肿瘤,术中发现枕部皮肤、枕骨内板、脑膜及皮层均明显黑染,术后病理证实原发性黑色素瘤。虽然病人高龄,但术后临床症状消失,日常生活能自理,术后10个月影像学检查未见肿瘤复发,也未发现肿瘤远处转移。这提示高龄原发性脑室黑色素瘤,严格把握手术适应证,充分术前准备,可以考虑手术治疗。Intracranial primary melanoma is a rare tumor,yet it is extremely rare in the fourth ventricle.The prognosis of patients varies due to differences in tumor differentiation degree,location,and extent of resection.Hence,accurate preoperative diagnosis,complete tumor resection during the operation as much as possible,and supplemented with postoperative radiotherapy are the keys to improving the prognosis of patients.This paper reports a case of an 81-year-old patient.Both preoperative head CT and enhanced MRI examinations indicated a tumor in the fourth ventricle.After completing preoperative preparations,the tumor was completely resected under the microscope.During the operation,it was discovered that the occipital skin,the inner plate of the occipital bone,the meninges,and the cortex were all conspicuously blackened.Postoperative pathology confirmed primary melanoma.Although the patient was of advanced age,the clinical symptoms disappeared after the operation,and he was able to take care of himself in daily life.No tumor recurrence was found in imaging examinations 10 months after the operation,nor was distant metastasis detected.This indicates that for elderly patients with primary ventricular melanoma,by strictly grasping the surgical indications and conducting adequate preoperative preparations,surgical treatment can be considered.

关 键 词：原发性脑室肿瘤 黑色素瘤 第四脑室 显微手术 高龄 

分 类 号：R739.41[医药卫生—肿瘤] R651.11[医药卫生—临床医学]