Analysis Of Clinical Features And Prognostic Factors Of Ependymal Tumors In The Fourth Ventricle

Objective:To explore the clinical features of the fourth ventricle ependymal tumors and the factors affecting the prognosis of patients,hoping to provide data and guidance for clinical diagnosis and treatment.Materials and Methods:This research mainly collects the 45 patients from 2004 to 2019 in the central campus of QILU hospital of Shandong university in the fourth ventricle ependymal tumor who are received operation in neurosurgery.All patients are confirmed of ependymal tumors with postoperative pathology.Collecte the patients clinical characteristics and postoperative follow-up data.Summarize and analyze clinical characteristics of the disease.Statistic and analysis of the collected information.Appliy the SPSS24.0 statistical software to deal with the data,analyzes and explore the relevant factors affecting the prognosis of patients and draw survival curves,which has statistical significance for P values<0.05.Results:Among the 45 patients who meet the requirements of age between 1 year and 68 year old,including 21 male and 24 female patients with the ratio of 0.875:1.000.21 cases are younger than 30 years.24 cases are older than 30 years;The average age is 28.36 years old.The course of disease is from 5 days to 8 years.The most common clinical symptoms that occurred for the first time are dizziness in 30 cases,headache in 21 cases,nausea and vomiting in 19 cases,walking instability in 12 cases,neck discomfort in 6 cases,vision and eye movement disorders in 5 cases,fatigue in 3 cases,drinking choking or cranial nerve symptom in 1 case,tinnitus in 1 case,and leg pain in 1 case,physical examination not been cooperated in 4cases.In the positive signs,the finger-nose test(+)in 7 cases;The closed eye is difficult to stand in 8 cases;The heel knee and tibia test is not stable in 5 cases;Straight walking is not been performed in 7 cases;There are 1 case of high tension,1 case of hyperreflexia,3 cases of positive pathological signs,4 cases of obvious fundus edema,2 cases of nystagmus,2 cases of fine movements,1 case of torticollis,and 4 cases of incomplete physical examination.All patients take imaging examinations such as cranial CT or MRI before operation.Imaging density or signal length are different.The imaging diagnosis is the same as the post-operative pathological diagnosis in 24 cases,while the difference in 21 cases.Preoperative imaging reveale 42 cases of hydrocephalus with different degrees;3 cases have no hydrocephalus.The diameter of the tumor is 2 to 6cm.The treatment is mainly surgical treatment.Adjuvant radiotherapy or chemotherapy are given postoperatively.45 cases are accepted surgery;15 cases are obtained with total resection,and 30 cases are obtained with nearly total resection.22 cases are with postoperative radiotherapy;10 cases are with secondary or more operations;4 cases accept chemotherapy;3 cases accept Gamma knife treament.There are 24 deaths,including 9 perioperative and 15 tumor recurrence deaths.Postoperative pathology is classified according to WHO,including 1 case in grade ?,33 cases in grade ?,and 11 cases in grade ?.There are 33 cases of ependymoma,8 cases of anaplastic(malignant)ependymoma,1 case of mucinous papillary ependymoma,and 3 cases of mixed type.7 cases of hydrocephalus after operation require surgical treatment,5 cases of ventricul-operitoneal shunt,and 2 cases of endoscopic triventricular endotomy.There are 17 cases of tumor recurrence after operation.The first time of the recurrence is from 2 months to 22 years,and the average time is 74.35 months.6 cases are multiple implant metastases.20 cases are of brain stem involvement;22 cases are of cerebellum involvement,according to the surgery or imaging.The common long-term complications after surgery:18 cases of head discomfort such as headache and dizziness,5 cases of cranial nerve symptoms in the posterior group,13 cases of cerebellar symptoms,10 cases of fine movement or limb movement disorders,6 cases of inability to life themselves,3 cases of vision changes or eyeballs mobility impairment.45 cases are followed up after operation;21 cases are still alive.The 5-year overall survival rate is 31.11%(14/45);The 5-year progression-free survival rate is 57.78%(26/45).The follow-up time is 4 days to 30 years.The overall survival period of the disease is 11 days to 31 years.According to the follow-up results,the 5-year survival rate and progression-free survival rate are calculated for gender,age,preoperative hydrocephalus,resection degree,brain stem or cerebellum involvement,pathological classification or grade of tumor,postoperative radiotherapy or chemotherapy,etc;And draw relevant survival curves.Tumor classification or grade,postoperative radiotherapy,cerebellar involvement are statistically significant of univariate analysis of 5-year survival rate.Tumor classification or grade,post-radiotherapy are statistical significance of univariate 5-year progression-free survival rate.Tumor classification or grade,postoperative radiotherapy are statistically significant of multivariate analysis of the 5-year survival rate.Tumor classification or grade is the only statistically significant of multivariate 5-year progression-free survival rate.Conclusions:1.The ependymal tumor of the fourth ventricle is mainly symptomatic of increased intracranial pressure of hydrocephalus,and has no obvious specificity with the clinical manifestations of other intracranial tumors.2.Preoperative cranial CT and MRI are the main imaging examinations for the qualitative diagnosis of tumors.But there are certain missed or misdiagnosed rate,and the final diagnosis depends on pathological diagnosis.3.Pathological grading or classification,and radiotherapy are independent factors that affect the prognosis of patients.The lower the grade or postoperative radiotherapy patients,the better the prognosis is.The high grade has a higher 5-year survival rate and no progress rate,but the overall survival rate is lower;4.The prognosis needs to comprehensively consider the degree of total resection during surgery,postoperative pathological analysis,postoperative radiotherapy and chemotherapy,cerebellar involvement,brainstem involvement and other comprehensive factors.