Observation on surgical efficacy of pediatric pontine tumor adjacent to the fourth ventricle with paroxysmal ocular movement abnormalities and hemifacial spasm
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 clinical cure;their paroxysmal symptoms may be related to the abnormal discharge of the tumor.
NETL
NSTL
万方数据
