Subfrontal recurrence after cerebellar medulloblastoma resection without local relapse: case-based update
Subfrontal recurrence after cerebellar medulloblastoma resection without local relapse: case-based update
复制标题
小脑髓母细胞瘤切除后额下复发但无局部复发：基于病例的更新
DOI：
10.1007/s00381-018-3869-8
复制
发表时间：
2018-09-01
影响因子：
1.4
通讯作者：
Guo Dongsheng
中科院分区：
文献类型：
--
作者：
He Yue;Wang Ling;Guo Dongsheng
本文报告4例小脑髓母细胞瘤切除术后额下区肿瘤复发，无局部复发，并探讨复发原因。此外，一个基于案例的更新和洞察实体attempted.MethodsAll四例患者接受小脑髓母细胞瘤切除术和术后放疗。当他们被发现在前颅底额下区域有复发性肿瘤时，他们被收住到我们医院。所有4例患者均接受了肿瘤再次切除术，术后病理结果证实为复发性髓母细胞瘤。2例患者均在2年内因肿瘤转移或肿瘤复发导致多器官功能衰竭而死亡。结论髓母细胞瘤转移至额下区并复发是罕见的。放射剂量不足、重力相关的避难所效应、手术体位和围手术期脑积水处理可能是导致幕上脑膜复发的因素。通过在初次手术中进行广泛的显微手术肿瘤切除，在围手术期脑积水治疗中尽量减少永久性V-P分流的需要，以及对额下区筛板区域进行全剂量放射治疗，可以更好地预防肿瘤复发。
ObjectiveThis report detailed four cases of tumor recurrence in the subfrontal region after cerebellar medulloblastoma resection without local relapse and explored the causes of recurrence. In addition, a case-based update and insight into the entity is attempted.MethodsAll four patients received cerebellar medulloblastoma resection and postoperative radiotherapy. They were admitted to our hospital when they were found to have a recurrent tumor in the subfrontal region of the anterior skull base. All four patients received re-resection of the tumor, which was confirmed to be recurrent medulloblastoma by postoperative pathological results.ResultsAll patients received local radiotherapy and temozolomide chemotherapy after recurrent tumor resection. They all died due to multiple organ failure resulting from tumor metastasis to other sites or tumor regrowth within 2 years after the second operation.ConclusionMedulloblastoma metastasize to the subfrontal region and develop a homogenous recurrence is rare. Underdosage of radiation, a gravity-related sanctuary effect, surgical position, and perioperative hydrocephalus management might be factors contributing to this supratentorial meningeal recurrence. A better prevention of tumor recurrence might be achieved by extensive microsurgical tumor resection in the initial operation and by minimizing the need for a permanent V-P shunt in the treatment of perioperative hydrocephalus as well as by administering full-dose radiotherapy to the region of the cribriform plate in the subfrontal area.