Clinical Review Of Fourth Ventricular Tumors: Report Of 161 Cases

Objective:To conclude the experience of the diagnosis and treatment of fourth ventricular tumors.Methods: The data of 161 patients from January 1990 to June 2008 with fourth ventricular tumors pathologically verified by surgery were analyzed retrospectively. The clinical profile ,including the imaging and pathological characteristics,clinical manifestations, surgical managements and postoperative complications were reviewed and analyzed.Results: Of the 161 patients, total resection was achieved in 142 cases(88.2%), subtotal resection in 19 cases(11.8%),and the overall mortality was 3.7%(6/161).The pathological diagnoses were Medulloblastoma(50 cases), ependymoma(39 cases), astrocytoma(18 cases),epidermoid cyst(20 cases),hemangioblastoma(9 cases),choroid plexus papilloma(8 cases),meningeal tumor(4 cases),germ cell tumor(4 cases), cavernous hemangioma(3 cases),choroidal cyst(3 cases),inflammatory granuloma(2 cases) and metastatic carcinoma(1 cases). Dysphagia occurred postoperatively in 15 patients, facial paralysis in 6 patients, diplopia in 7 patients, physical inability in 4 patients, cereberal mutism in 1 patient ,pulmonary infection in 17 patients, stress ulcer in 5 patients, intracranial infection in 10 patients, subdural hydrops in 2 patients, subcutaneous hydrocele in 7 patients,and hydroencephalus in 28 patients.Conclusion: The fourth ventricular tumors were particularly prevalent in juvenile. The most common pathological type were medulloblastoma and ependymoma. CT and MRI are the initial choice in the diagnosis of the fourth ventricular tumors. There is high risk for the surgical resection of the fourth ventricular tumors because of its neighbourring to the dorsal part of the brain stem. It is important to protect the functions of the brain stem during the tumor resection. Maneuvers to prevent and treat postoperative complications were beneficial to improve the surgical outcome of the fourth ventricular tumors.