侧脑室肿瘤总结解读

J Neurosurg 88:581–585, 1998

Multiple choroid plexus papillomas of the lateral ventricle distinct from villous hypertrophy

侧脑室多发脉络丛乳头状瘤

FIG. 1. Axial T1-weighted MR images revealing slightly hypointense to isointense lesions in the right atrium and left inferior horn of the lateral ventricles (upper), and Gd-DTPA–enhanced images demonstrating a marked homogeneous enhancement of the lesions (lower).

平扫及增强影像。

FIG. 2. Sagittal T1-weighted MR images with Gd-DTPA enhancement clearly revealing the anatomical relationship between the tumors and the surrounding structures, which marked their location more easily. Left: Sagittal images of the left side of brain. Center: Sagittal image of the center of brain. Right: Sagittal images of the right side of brain.

FIG. 3. Upper: Photomicrograph of the tumor specimen obtained during the first operation in the right ventricular region. Note the papillary growth of a single and partly stratified layer of columnar epithelium, consistent with a typical choroid plexus papilloma. Lower: Photomicrograph of the tumor specimen obtained during the second operation in the left ventricular region. The histopathological characteristics are similar to those shown in the right ventricular region. H & E, original magnification 3 200.

病理结果。

Acta Neurochir (2003) 145: 139–143 DOI 10.1007/s00701-002-1047-x Acta Neurochirurgica Printed in Austria Case Report

Choroid plexus papilloma of bilateral lateral ventricle

T. Erman1, A. I˙. Go¨c?er1, S? . Erdog?an2, M. Tuna1, F. I˙ldan1, and S. Zorludemir2

1Department of Neurosurgery, C? ukurova University, School of Medicine, Adana, Turkey

2Department of Pathology, C? ukurova University, School of Medicine, Adana, Turkey

Fig. 1. (a) Axial non-contrast CT scan demonstrating tumour of the lateral ventricles bilaterally and hydrocephalus. (b) Axial contrast enhanced CT scan demonstrating an enhancing tumour of the lateral ventricle bilaterally with hydrocephalus

(b) Axial contrast enhanced CT scan demonstrating an enhancing tumour of the lateral ventricle bilaterally with hydrocephalus

Fig. 2. Axial enhanced MRI demonstrating a lobulated enhancing mass in the bilateral lateral ventricular trigone

Fig. 2. Axial enhanced MRI demonstrating a lobulated enhancing mass in the bilateral lateral ventricular trigone

Transient memory disturbance after removal of an intraventricular trigonal meningioma by a parieto-occipital interhemispheric precuneus approach:Case report

肿瘤切除后记忆暂时紊乱

Koji Tokunaga, MDa,T, Takashi Tamiya, MDb, Isao Date, MDa

aDepartment of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan

bDepartment of Neurological Surgery, Faculty of Medicine, Kagawa University, Kagawa 700-8558, Japan

Received 15 December 2004; accepted 13 June 2005

Fig. 1. Left and center: Preoperative gadolinium-enhanced T1-weighted MR images demonstrating a homogeneously enhanced mass at the left trigonal region, extending predominantly in the anterior direction. Right: A T2-weighted MR image showing moderate

edema around the mass

Fig. 2. Left and right: Postoperative gadolinium-enhanced T1-weighted images demonstrating the route approaching the left trigone from the interhemispheric fissure and confirming complete removal of the tumor

Symptom Changes Caused by Movement of a Calcified Lateral Ventricular Meningioma CASE REPORT

Shigeki Imaizumi, M.D.,* Takehide Onuma, M.D.,* Motonobu Kameyama, M.D.,* and Kiyoshi Ishii, M.D.?

*Departments of Neurosurgery and ?Radiology, Sendai City Hospital, Sendai, Japan

Sequential CT studies over 16 years revealed no distinctive change in size of the calcified meningioma (A-D). CT taken 16 years before this admission (A). Hydrocephalus and peritumoral edema caused by a tumor in the ventricle were seen at admission (B). The ventricle size was normalized after ventriculoperitoneal shunt placement (C). The tumor was displaced beyond the ventricular midline five months later (D). Half of the tumor was resected during the 1st surgery using the trans callosal route (E) and the remaining mass was removed during the second surgery using the trans inferior temporal sulcus approach (F).

Hemangiopericytoma in the Trigone of the Lateral Ventricle—Case Report—

Fig. 1 Axial computed tomography scan showing a massive right tri gonalmass, with dilation of

the contralateral ventricle.

Fig. 2 (A) Preoperative axial T1-weighted magnetic resonance (MR) image showing a large, isointense trigonal tumor. (B) T2-weighted MR image showing the hypointense tumor. (C) Sagittal T1-weighted MR image with contrast medium showing intense enhancement of the tumor.

Neurol Med Chir (Tokyo)

Child’s Nerv Syst (1998) 14:350–353

? Springer-Verlag 1998 BRIEF COMMUNICATION

Meningiomas of the lateral ventricles of the brain in children

Fig. 1 MRI showing intraventricular mass

Fig. 2 CT 2 weeks after operation, showing complete removal of tumour Fig. 3 CT scan showing intraventricular neoplasm in trigone region Fig. 4 CT 6 months after operation, showing complete removal of tumour

Acta Neuropathol (Berl) (1986) 71 : 167-- 170 Acta

Neuropathologlca

9 Springer-Verlag 1986

Central neurocytoma - a rare benign intraventricular tumor

j . j . Townsend I, 2 and J. P. Seaman 3

Department of Pathology, University of Utah

2 Salt Lake Veterans Administration Medical Center

3 LDS Hospital, Salt Lake City, UT, USA

Fig. 1. This picture demonstrates the well-circumscribed soft tumor mass (in the anterior right lateral ventricle) attached to the septum pellucidum and corpus callosum (case 1)

Fig. 2. The CT scan demonstrates the well-circumscribed mass in the right lateral ventricle anteriorly producing hydrocephalus (case 2)

Fig. 3. This print demonstrates the tumor to be composed of small dark nuclei forming occasional Homer Wright rosettes as seen in the center of the picture (case 1). Hematoxylin and eosin, x 800

Fig. 4. The tumor was composed of small round to oval nuclei which formed Homer Wright rosettes as seen in the center (case 2).Hematoxylin and eosin, x 375

Fig. 5. The neurosecretory granules can be seen in this electron micrograph, x 27,173

Fig. 6. Electron microscopy demonstrated numerous synapses with well-formed junctions as seen in the center, x 27,173

Journal of Clinical Neuroscience (1999) 6(4), 319-323

? 1999 Harcourt Brace & Co. Ltd

Clinical studies

Intraventricular neurocytoma: a clinicopathological study of 20 cases with review of the literature

Mehar Chand Sharma ~ MD, Chitra SarkaP MD, Asis Kumar Karak ~ MD PHD, Sailesh Gaikwad 2 MD,

Ashok Kumar Mahapatra a MCH, Veer Singh Mehta a MCH

Fig. 1 Contrast enhanced CT scan showing a well defined hyperdense mass, predominantly in the right lateral ventricle with cyst formation and secondary hydrocephalus (Case 16).

Fig. 2 Photomicrographs showing: (A) cellular areas separated by acellular fibdllary zones (H&E x 350); (B) thin walled dilated vascular channels within the tumour (H&E × 140); (C) diffuse

fibrillary immunostaining with synaptophysin antibody (x 200)

Case report

Epidermoid of the lateral ventricle: evaluation with diffusionweighted and diffusion tensor

imaging

表皮样囊肿

Radboud W. Koot a, Anuradha P. Jagtap b, Erik M. Akkerman b, Gerard J. Den

Heeten b, Charles B.L.M. Majoie b,*

a Department of Neurosurgery, Academic Medical Center, P.O. Box 22660, 1100 DD Amsterdam,

Netherlands

b Department of Radiology, Academi

c Medical Center, P.O. Box 22660, 1100 DD Amsterdam,

Netherlands

Received 4 March 2003; accepted 14 March 2003

Fig. 1. (A, B, C): (A) Axial T2-weighted (3500/90/1), and axial (B) and coronal (C), contrast

enhanced T1- weighted (570/40/2) MR images show enlarged left lateral ventricle with mass

effect and shift of midline structures to the right. Note widening of the left choroidal fissure (C;

arrow). A definite tumor cannot clearly be delineated. (D, E) Axial DWI shows a hyperintense

lesion in the left perimesencephalic cistern (D; arrow) and in the dilated left lateral ventricle (E).

The mass is surrounded by hypointense CSF. Findings are consistent with epidermoid tumor. (F) ADC map at the same level as (E) show ADC values in the lesion similar to brain parenchyma.

(G) FA maps of the lesion show areas of anisotropy, clearly demonstrate its relationship to neighboring white matter tracts and accentuate the lobulated structure of the lesion (tensor-imaging).

Fig. 1. (A, B, C): (A) Axial T2-weighted (3500/90/1), and axial (B) and coronal (C), contrast enhanced T1- weighted (570/40/2) MR images show enlarged left lateral ventricle with mass effect and shift of midline structures to the right. Note widening of the left choroidal fissure (C; arrow). A definite tumor cannot clearly be delineated. (D, E) Axial DWI shows a hyperintense lesion in the left peri mesencephalic cistern (D; arrow) and in the dilated left lateral ventricle (E). The mass is surrounded by hypointense CSF. Findings are consistent with epidermoid tumor. (F) ADC map at the same level as (E) show ADC values in the lesion similar to brain parenchyma.

(G) FA maps of the lesion show areas of anisotropy, clearly demonstrate its relationship to neighboring white matter tracts and accentuate the lobulated structure of the lesion

(tensor-imaging).

A large arachnoid cyst of the lateral ventricle extending from the supracerebellar cistern—case report

Seoung Woo Park, MDa, Soo Han Yoon, MDb,*, Ki Hong Cho, MDb, Yong Sam Shin, MDb

aDepartment of Neurosurgery, Kangwon National University, College of Medicine, Chunchon 200-701, South Korea bDepartment of Neurosurgery, Ajou University School of Medicine, Suwon 443-721, South Korea

Received 23 May 2005; accepted 30 July 2005

Fig. 1. Initial MRimaging shows that the arachnoid cyst had developed from the supracerebellar space in the posterior fossa and extended into the antrum and temporal horn of the left lateral ventricle. A and B: Axial MR imaging shows that the intraventricular cyst displaces the left choroidal vessels anteriorly (small arrow heads), the right choroid plexus laterally (smallarrow), the midline vessels to the right (large arrow), and an enlarged velum interpositum. C: Axial MR imaging shows that the left choroid plexus (small arrow) was severely displaced anteriorly and the thin cystic wall (arrow head)

crossed the right lateral ventricle. D and E: CoronalMRimages show that the cyst (small arrow heads) displaces the left choroids plexus contralaterally (arrow) and the right choroid plexus and choroidal vessels laterally (large arrow head). F: Coronal MR images shows displaced and collapsed right choroids plexus (small arrow), branching portion of choroidal vessels (large arrow), and left choroidal vessels (arrow head). G: Sagittal MR imaging shows that the cyst of the posterior fossa depressing the cerebellum downwardly (arrows) extending into and dilating the velum interpositum (small arrow heads) with anteriorly displaced contralateral choroid plexus (large arrow). H: Sagittal MR imaging shows the herniation of cerebellum (arrow) with visualization of the central canal of the cervical spinal cord (arrow heads).

Clinical Study

Intraventricular tanycytic ependymoma: case report and review of the literature

Brian T. Ragel1, Jeannette J. Townsend2, Adam S. Arthur1 and William T. Couldwell1

1Department of Neurosurgery; 2Department of Pathology, University of Utah Health Sciences Center, Salt Lake City,

UT, USA

Key words: supratentorial tumors, tanycytic ependymoma

Figure 1. Brain MRI depicting 2.8 · 2.6 · 2.3 cm (height · transverse · anterior–posterior) lesion arising from the region of the left superolateral third ventricle and septum pellucidum. Mass extends superolaterally into the left frontal horn of the lateral ventricle. (A) Axial T1 with contrast, showing minimal enhancement. (B) Axial T2, showing heterogenous signal. (C) Coronal T1 with contrast, with incidental left sphenoid wing meningioma (arrow). (D) Coronal FLAIR sequence.

Figure 2. (A) Low-power H&E stain (150·) showing moderately cellular tissue with areas of well-differentiated streaming tumor cells set in a vague fascicular architecture and faint perivascular pseudorosettes (black arrow). (B) High-power H&E photomicrograph (300X) depicting tumor cells arranged radially around a blood vessel, typical of the perivascular pseudorosettes of ependymomas (black arrow). (C) High-power photomicrograph (600X) of GFAP immunohistochemistry reactivity, depicting the delicate GFAP-positive processes of ependymal cells radiating towards the blood vessel wall (black arrow).

Shunji Nishio · Takato Morioka · Futoshi Mihara

Masashi Fukui

Subependymoma of the lateral ventricles

Fig. 1 Case 1. Enhanced CT scan shows a low density tumor in the right lateral ventricle

Fig. 2A–C Case 3. On contrast enhanced axial T1-weighted image, a hypointense

intraventricular tumor shows no tumor enhancement. Note cystic areas within the tumor and associated hydrocephalus (A). While the tumor is indistinguishable from the cerebrospinal fluid in the ventricle on T2-weighted image (B), it is clearly distinguished on heavily T2-weighted image (C)

Fig. 3A–C Case 4. Axial T1-weighted precontrast MRI shows a hypointense tumor filling the anterior horn of the right lateral ventricle (A). A T2-weighted MRI shows peritumoral edema in the right frontal lobe (B). Axial T1-weighted postcontrast MRI shows heterogeneous enhancement of the tumor (C)

Massive symptomatic subependymoma星状细胞增生性室管膜瘤of the lateral ventricles: case report and review of the literature

大的症状性瘤

Fig. 1 Axial pre- (a) and post- (b) contrast-enhanced computed tomography (CT) of the head shows a large symmetric isodense intraventricular mass without calcifications filling the lateral ventricles and extending into the temporal horns

Fig. 2 Axial T2-weighted and fluid attenuation inversion recovery (FLAIR) images (b, c) show a large symmetric hyperintense intraventricular mass that fills the lateral ventricles (a, b) and the temporal horns

Fig. 3 Axial (a) and coronal T1-weighted (b) post-contrastenhanced images demonstrate an intraventricular mass with minimal enhancement occupying the lateral ventricles and extending into the temporal horns

Fig. 5 Axial T2-weighted (a),FLAIR (b), and T1-weighted(c) post-contrast-enhanced

images demonstrate a slight debulking of the tumor after surgery with CSF present in the frontal horns of the lateral ventricle. The patient has a right frontal ventriculoperitoneal shunt catheter in place and is presently asymptomatic

Fig. 4 Resection specimen reveals a subependymoma, as characterized by nests of tumor cell nuclei and microcysts in a fibrillary stroma

Multicentric juvenile pilocytic astrocytoma occurring primarily in the trigone of the lateral ventricle

Fig. 1 A Pre- and B post-contrast enhancement computerized tomography showing a

7′6′6 cm mixed-density mass in the trigone of the left lateral ventricle entrapping the ipsilateral occipital horn. The solid compartment and cystic wall are well enhanced. There were conglomerate calcifications in the posteromedial portion of the mass. Hydrocephalus is also noted Fig. 2A–D Preoperative magnetic resonance images (MRIs). A Axial T1-weighted MRI showing a mixed-intensity mass with sharp demarcation from the adjacent structures except the posteromedial portion of the mass. B–D Gadoliniumenhanced MRIs showing that the cystic wall and solid component are well enhanced and that the septum pellucidum and lateral ventricular wall, the perimesencephalic cistern, and the anterior meninges or ventral aspect of the brain stem are enhanced, suggesting leptomeningeal spread. Small enhanced nodules are also seen in the right anterior temporal and occipital lobes as nodular disease. Tonsillar herniation and mild distortion of the brain stem with enlargement of the IV ventricle are also shown

Fig. 3 Photomicrograph of the trigonal juvenile pilocytic astrocytoma showing the typical histological features, including pilocytic, stellate, and oligodendroglial cells, microcysts, cytoid or granular bodies, and Rosenthal fibers with loose and compact areas. Vascular proliferation

and pleomorphism are absent. (H & E, ′250)

Intraventricular Hemangiopericytoma

Nabeel Al-Brahim, MD, Rocco Devilliers, MD, FRCS(C), and

John Provias, MD, FRCP(C)

Figure 1. Axial T1-weighted magnetic resonance image shows a well delineated tumor in the right lateral ventricle.

Figure 2. Contrast-enhanced T1-weighted image shows homogenous enhancement of the tumor.

侧脑室肿瘤总结

J Neurosurg 88:581–585, 1998 Multiple choroid plexus papillomas of the lateral ventricle distinct from villous hypertrophy 侧脑室多发脉络丛乳头状瘤 FIG. 1. Axial T1-weighted MR images revealing slightly hypointense to isointense lesions in the right atrium and left inferior horn of the lateral ventricles (upper), and Gd-DTPA–enhanced images demonstrating a marked homogeneous enhancement of the lesions (lower). 平扫及增强影像。 FIG. 2. Sagittal T1-weighted MR images with Gd-DTPA enhancement clearly revealing the anatomical relationship between the tumors and the surrounding structures, which marked their location more easily. Left: Sagittal images of the left side of brain. Center: Sagittal image of the center of brain. Right: Sagittal images of the right side of brain.

侧脑室囊肿是什么

侧脑室囊肿是什么 相信有些准妈妈在产检的时候会发现胎儿侧脑室囊肿，这听起来很令人害怕，准妈妈们总是会想得比较多，长期这样，准妈妈会精神过于紧张，为了防止这种现象的发生，我们为大家介绍一下侧脑室囊肿是什么，准妈妈们也可以有个心理准备，保持乐观的心态，积极产检，才能给胎儿最好的保护。 目前认为侧脑室囊肿病理分型有：神经上皮样囊肿(包括脉络丛囊肿和室管膜囊肿)和蛛网膜囊肿，其中大多数为脉络丛囊肿。脉络丛囊肿是最常见的神经上皮样囊肿，多见于儿童，在整个脑室系统均可发生，最多见于侧脑室三角区，其次为侧脑室体部、枕角和颞角，额角罕见，与脉络丛的解剖分布有关。脉络丛囊肿常在胎儿时就已经发生，与第18号染色体三体有关，也可能和21号染色体变异有关，但是大多数在出生后2年内消失，并不影响婴幼儿的生长发育。 侧脑室囊肿可单发,也可多发.本病一般无任何症状,一旦囊肿阻塞脑脊液循环,则可以造成胎儿脑室扩张.脉络膜囊肿多在

早期妊娠晚期或中期妊娠早期发现,孕24~26周后明显缩小或消失. 侧脑室有囊性肿块一般对胎儿没有直接影响。如果囊肿比较小,而且在左侧侧脑室一般不会堵塞脑脊液循环,不造成颅内压 增高等。暂时可以先不处理这个囊肿的问题,如果胎儿未发现合并其他畸形,则可嘱孕妇随访观察,至妊娠结束。 检查中若发现胎儿脉络膜囊肿,不要立即认为是病理性或生理性的,应同时仔细检查胎儿是否合并有其他畸形,如果胎儿合 并有其他畸形时应建议孕妇行羊膜腔穿刺抽羊水作染色体检查,以尽早排除染色体疾病.如果胎儿未发现合并其他畸形,则可嘱 孕妇随访观察,至妊娠结束. 等生产完后,可以到神经外科就诊,可能需要定期复查,确定此囊肿的性质是良性的还是恶性的,然后确定治疗方案。 通过上面的介绍，对于侧脑室囊肿是什么，相信准妈妈们心中也有自己的理解了，其实，每个宝宝都是上天赋予我们的天使，作为准妈妈千万要放松自己的心情，如果发现侧脑室囊肿就要坚持复检，最后确定情况如何，这是为宝宝未来的健康保障，也是为每个家庭的幸福保障。

MRI对侧脑室肿瘤的鉴别诊断

?３１２?实用放射学杂志２０１０年３月第２６卷第３期ＪＰｒａｃｔＲａｄｉｏｌ，Ｍａｒ．２０１０，Ｖ０１．２６，Ｎｏ．３ ＭＲＩ对侧脑室肿瘤的鉴别诊断 王希明，郭亮，胡春洪，沈海林，谢道海，诸伟，陈剑华 （苏州大学附属第一医院放射科。江苏苏州２１５００６） 摘要：目的提高ＭＲＩ对侧脑室不同肿瘤的鉴别诊断水平。方法搜集侧脑室不同肿瘤２２例，其中脑膜瘤６例，星形细胞瘤３例，室管膜瘤２例，中枢神经细胞瘤２例，脉络丛乳头状瘤、少突胶质细胞瘤、室管膜下巨细胞型星形细胞瘤、生殖细胞瘤及肠源性囊肿各１例，转移瘤４例，回顾性分析其ＭＲＩ表现及其临床特点。结果本组中所有脑膜瘤及脉络丛乳头状瘤均发生于侧脑室三角部，全部中枢神经细胞瘤（２例）、室管膜下巨细胞型星形细胞瘤（１例）均发生于室间孔区及侧脑室前部；６例脑膜瘤及４例转移瘤均发生于３０岁以上，１例脉络丛乳头状瘤７岁，２例中枢神经细胞瘤年龄分别为２３岁、２４岁。６例脑膜瘤增强后呈明显均匀强化，２例中枢神经细胞瘤内可见多发囊变区，其中１例可见多发流空血管影，１例少突胶质细胞瘤内可见多发钙化灶，１例（１／３）星形细胞瘤可见瘤内出血。绪论侧脑室肿瘤的ＭＲＩ表现特点为其鉴别诊断的重要依据，肿瘤部位、发病年龄特征对于鉴别诊断也有一定参考价值。 关键词：脑；侧脑室肿瘤；磁共振成像ｄｏｉ：１０．３９６９／ｊ．ｉｓｓｎ．１００２—１６７１．２０１０．０３．００３ 中图分类号：Ｒ７３９．４１；Ｒ４４５．２文献标识码：Ａ文章编号：１００２—１６７１（２０１０）０３—０３１２—０５ ＭＲＩＤｉｆｆｅｒｅｎｔｉａｌＤｉａｇｎｏｓｉｓｏｆＬａｔｅｒａｌＶｅｎｔｒｉｃｕｌａｒＴｕｍｏｒｓ ＷＡＮＧＸｉ—ｒｕｉｎｇ，ＧＵＯＬｉａｎｇ。Ｈ【，Ｃｈｕｎ－－ｈｏｎｇ。ＳＨＥＮＨａｉ－－ｌｉｎ， ＸＩＥＤａｏ－－ｈａｉ，ＺＨＵＷｅｉ－ＣＨＥＮＪｉａｎ－－ｈｕａ （ＤｅｐａｒｔｍｅｎｔｏｆＲａｄｉｏｌｏｇｙ，ｔｈｅＦｉｒｓｔＡｆｆｉｌｉａｔｅｄＨｏｓｐｉｔａｌｏｆＳｏｏｃｈｏｗＵｎｉｖｅｒｓｉｔｙ－ Ｓｕｚｈｏｕ－ＪｉａｎｇｓｕＰｒｏｖｉｎｃｅ２１５００６。Ｃｈｉｎａ） Ａｂｓｔｒａｃｔ：ＯｂｊｅｃｔｉｖｅＴｏａｎａｌｙｚｅｔｈｅＭＲＩａｐｐｅａｒａｎｃｅｓａｎｄｃｌｉｎｉｃａｌｄａｔａｏｆｌａｔｅｒａｌｖｅｎｔｒｉｃｕｌａｒｔｕｍｏｒｓｉｎｏｒｄｅｒｔＯｉｍｐｒｏｖｅｔｈｅｄｉｆ－ｆｅｒｅｎｔｉａｌｄｉａｇｎｏｓｔｉｃａｃｃｕｒａｃｙｏｆｉｔ．Ｍｅｔｈｏｄｓ２２ｃａｓｅｓｏｆｌａｔｅｒａｌｖｅｎｔｒｉｃｕｌａｒｔｕｍｏｒｓｗｅｒｅｒｅｐｏｒｔｅｄ。ｉｎｃｌｕｄｉｎｇｍｅｎｉｎｇｉｏｍａ（ｎ＝６）。ａｓ—ｔｒｏｃｙｔｏｍａ（ｎ２３）。ｃｅｎｔｒａｌｎｅｕｒｏｃｙｔｏｍａ（ｎ＝２）－ｅｈｏｒｏｉｄｐｌｅｘｕｓｐａｐｉｌｌｏｍａ，ｏｌｉｇｏｄｅｎｄｒｏｇｌｉｏｍａ。ｓｕｂｅｐｅｎｄｙｍａｌｇｉａｎｔｃｅｌｌａｓｔｒｏｃｙｔｏｍａ－ｇｅｒｍｉｎｏｍａａｎｄｅｎｔｅｒｏｇｅｎｏｕｓｃｙｓｔ（ｎ。１ｆｏｒｅａｃｈ）ａｎｄｍｅｔａｓｔａｓｅｓ（ｎ－－－－４）．ＭＲＩｍａｎｉｆｅｓｔａｔｉｏｎｓａｎｄｃｌｉｎｉｃａｌｄａｔａｏｆ２２ｐａｔｉｅｎｔｓｗｅｒｅａｎａｌｙｚｅｄｒｅｔｒｏｓｐｅｃｔｉｖｅｌｙ．ＲｅｓｎｌｔｓＡｌｌｏｆｔｈｅｍｅｎｉｎｇｉｏｍａｓａｎｄｃｈｏｒｏｉｄｐｌｅｘｕｓｐａｐｉｌｌｏｍａｌｏｃａｔｅｄｉｎｖｅｎｔｒｉｃｕｌａｒｔｒｉｇｏｎｅ。ｗｈｉｌｅａ１１ｏｆｔｈｅｃｅｎｔｒａｌｎｅｕｒｏｃｙｔｏｍａａｎｄｓｕｂｅｐｅｎｄｙｍａｌｇｉａｎｔｃｅｌｌａｓｔｒｏｃｙｔｏｍａｌｏｃａｔｅｄｉｎｃｏｒｎｕａｎｔｅｒｉｕｓａｎｄｉｎｔｅｒｖｅｎｔｒｉｃｕｌａｒｆｏｒａｍｅｎ．Ｔｏｍｌｍｅｎｉｎｇｉｏ—ｍａｓａｎｄｍｅｔａｓｔａｓｅｓｏｃｃｕｒｒｅｄｉｎｐａｔｉｅｎｔｓｏｖｅｒ３０ｙｅａｒｓｏｌｄ。１ｃｈｏｒｏｉｄｐｌｅｘｕｓｐａｐｉｌｌｏｍａｏｃｃｕｒｒｅｄｉｎｃｈｉｌｄ（７ｙｅａｒｓｏｌｄ）ｌ２ｃｅｎｔｒａｌｎｅｕｒｏ—ｃｙｔｏｍａｏｃｃｕｒｒｅｄａｔ２３ａｎｄ２４ｙｅａｒｓｏｌｄｒｅｓｐｅｃｔｉｖｅｌｙ．Ｔｏｔａｌｍｅｎｉｎｇｉｏｍａｓｅｎｈａｎｃｅｄｍａｒｋｅｄｌｙａｎｄｈｏｍｏｇｅｎｅｏｕｓｌｙａｆｔｅｒｃｏｎｔｒａｓｔａｄ—ｍｉｎｉｓｔｒａｔｉｏｎ．Ｔｈｅｒｅｗｅｒｅｍｕｌｔｉｐｌｅｃｙｓｔｉｃａｒｅａｓｉｎ２ｃｅｎｔｒａｌｎｅｕｒｏｃｙｔｏｍａ．ｓｏｍｅｖｏｉｄｂｌｏｏｄｖｅｓｓｅｌｓｃｏｕｌｄｂｅｓｅｅｎｉｎｏｎｅｔｕｍｏｒ．Ｉｎｔｒａｔｕ—ｍｏｒａｌｈｅｍｏｒｒｈａｇｅｃｏｕｌｄｂｅｓｈｏｗｅｄｉｎ１ｏｆｔｈｅ３ｃａｓｅｓｗｉｔｈａｓｔｒｏｃｙｔｏｍａ．ＣｏｎｃｌｕｓｉｏｎＴｈｅｄｉｆｆｅｒｅｎｔｉａｌｄｉａｇｎｏｓｉｓｏｆｌａｔｅｒａｌｖｅｎｔｒｉｃｕｌａｒｔｕｍｏｒｓｍａｉｎｌｙｄｅｐｅｎｄｅｄｏｎｔｈｅｉｒＭＲＩａｐｐｅａｒａｎｃｅｓ．ｄｉｆｆｅｒｅｎｔｉａｌｄｉａｇｎｏｓｔｉｃａｃｃｕｒａｃｙｃａｎｂｅｉｍｐｒｏｖｅｄｗｈｅｎｃｏｍｂｉｎｉｎｇｗｉｔｈｔｈｅｓｐｅｃｉｆ．ｉｃｔｕｍｏｒｌｏｃａｔｉｏｎａｎｄｐａｔｉｅｎｔａｇｅ． Ｋｅｙｗｏｒｄｓ：ｂｒａｉｎ；ｌａｔｅｒａｌｖｅｎｔｒｉｅｕｌａｒｎｅｏｐｌａｓｍ；ＭＲｉｍａｇｉｎｇ 侧脑室肿瘤是指原发于侧脑室室壁或侧脑室周围结构、甚至异位组织，全部或大部占据脑室空间的肿瘤，占颅内肿瘤的１％～３．２％［１］。侧脑室肿瘤起源复杂，种类较多，术前影像学正确诊断对治疗方案的制订有着重要的意义。笔者回顾性分析２２例侧脑室肿瘤患者的病例资料，旨在提高ＭＲＩ对侧脑室肿瘤的鉴别 收稿日期：２００９一０５一１２ 作者简介：王希明（１９７３一）。男，山东省潍坊市人，主治医师，硕士。研究方向：肿瘤影像诊断．诊断水平。 １材料与方法 １．１一般资料收集本院２００３—０１—２００９－－０３的侧脑室肿瘤２２例，其中男８例，女１４例。年龄７～７７岁，平均４３．８岁。１８例经手术病理证实，４例转移瘤３例原发肿瘤为肺癌，１例为胃癌。病例的选择标准为：瘤体全部或大部位于侧脑室内，邻近脑室被撑开或周 围见脑脊液。

侧脑室肿瘤

侧脑室肿瘤 【概述】 侧脑室左右各有一个，形状不规则，位于额叶、顶叶、枕叶及颞叶内。分为前角、下角、后角、体部和三角区5个部分，内含脑脊液，是由侧脑室内的脉络膜组织所分泌侧脑室内肿瘤是指来源于侧脑室壁、脉络膜组织及异位组织的肿瘤。常见者有脑膜瘤、室管膜瘤、脉络膜乳头状瘤及上皮样囊肿，其中以脑膜瘤为最多。根据大量病例的统计侧脑室的前部以胶质瘤为多见，后部多发生脑膜瘤，脉络膜乳头状瘤则多发生于三角区，并可向脑室的其它部位延伸，有时可通过室间孔而长入第三脑室。但总的看来侧脑室肿瘤多发生于侧脑室的前部及三角区。可见于任何年龄，但以20岁以前发病者较多，左侧似多于右侧，男多于女。 【临床表现】 脑室为脑内的空腔，内含脑脊液，因此其临床表现取决于肿瘤的大小和部位，只有当肿瘤阻塞了脑脊液循环通路，或当肿瘤压迫其周围脑组织时才出现相应的症状和体征。如颅内压增高症和病灶症状。 1.颅内压增高侧脑室内肿瘤当其体积很小或未引起脑脊液循环受阻时，病人可完全没有任何明显症状。当脑脊液循环发生障碍后（室间孔阻塞、脑室部分梗阻），而出现颅内压增高症，在临床上则表现为头痛。头痛也是大部分病人的首发症状，据资料统计，以头痛为首发症状者约占侧脑室肿瘤病人的9 2.5%。头痛常呈发作

性、间歇性或阵发性加重。当室间孔或脑室的一部分（上角或下角）被阻塞时则造成梗阻性脑积水，因脑室的急剧扩张，病人头痛常难以忍受，头痛严重时病人出现恶心与呕吐。有的病人可因突然的颅内压增高产生脑疝导致昏迷甚至死亡。肿瘤在侧室内有一定的活动度，常呈活瓣状而突然阻塞脑脊液循环通路，造成急性颅内压上升，这也是发作性头痛产生的原因。当因体位或头位发生变动使脑室受阻的情况解除时，病人头痛可很快停止。如再次阻塞，随之头痛再次发生，如此可反复多次发作。因此有少数病人于每次发作时常以前额撞地或呈屈膝俯卧位。 病人在头痛剧烈时常出现强直性痉挛或因脑疝形成而死亡。由于长期颅内压增高病人出现视力减退，小儿可有头颅的增大，叩之呈“破壶音”。 2.局灶症状局灶症状或称为定位体征，当肿瘤体积较小未压迫或未侵犯周围脑组织时不产生任何定位体征。由于肿瘤的不断生长对各不同部位的周围脑结构产生压迫或破坏，而出现各种不同的脑损害症状和体征。肿瘤可累及内囊、基底节，也可向脑实质内生长，从而病人出现半身或单肢型的瘫痪和感觉障碍，以及病灶对侧较轻的中枢性面瘫，同向性偏盲等。如果左侧颞、顶、枕交界区受到侵犯，病人将出现失认及失语症。脑室周围组织受累及所产生的临床症状的严重程度常随颅内压力的变化而变化。当颅内压严重升高时，症状变得明显，颅内压下降时可暂时得到缓解。