| Objective: To explore the experience of the diagnosis and treatment of infratentorial tumors in children, in order to make early diagnosis, get reasonable treatment and improve prognosis.Methods: 139 cases(91 cases were pathologic diagnosis )from July 2003 to December 2009 with infratentorial tumors admitted into Children's Hospital of Chongqing Medical University were analyzed retrospectively. The age and sex distribution, clinical manifestation, location of tumor, imaging and pathological characteristics, microsurgical treatment and postoperative complications were reviewed and analyzed.Results: (1)In the study,the age range was from 4 months to 15 years,the average age was(5.95+3.89)years and 0-3years,4-9 years,10-15years were accounted for 30.21%,43.17%,26.62% respectively. Male to female ratio was 1.44:1.(2)The main clinical manifestations were vomiting(94 cases,67.6%),headache(73 cases,52.5%),instability of gait or ataxia (67 cases,48.2%) and cervical rigidity(37 cases, 26.6%). 115 cases(82.7%)visited a doctor in the course of disease from 1 to 90 days. 42 cases(30.2%) were misdiagnosed.(3)The tumors of 40 cases(28.8%)were located in fourth ventricular, while 53 cases(38.1%)in cerebellar hemisphere,12 cases(8.63%)in vermis,27cases(19.4%)in brain stem,7cases(5.03%)in cerebellopontine region. The top three of tumors were medulloblastoma(33 cases,36.3%),astrocytoma(28cases,30.8%),ependymoma(21cases,23.1%).(4)Obstructive hydrencephalus was found in 109 cases(78.4%)by imaging examination,in which 81 cases were moderate to severe. Positive rate of tumors qualitative diagnosis was 61.5%(94/98)by brain MRI.(5) 91 cases were treated by operation. Total resection was achieved in 81 cases(89.01%),subtotal resection in 6 cases(6.6%),partial resection in 4 cases (4.39%),and clinical cure in 84 cases, automatic discharged in 5 cases, mortality in 2 cases. 62 cases conducted outside the hospital for further radiotherapy and chemotherapy. 48 cases were treated by V-P shunt or abandoning surgical therapy.(6) In these surgical cases,11 cases had postoperative intracranial infection , 11 cases had local effusion , 6 cases had aggravating hydrocephalus , 5 cases had intracranial hematoma , 4 cases had supratentorial subdural effusion,3 cases had mutism, 3 cases had pneumonia and 1 case had stress ulcer.Conclusions: (1)The incidence of 4 to 9 years old children is the highest in this group.The incidence of boys is higher than girls. (2)The top three of tumors are medulloblastoma,astrocytoma and ependymoma .(3)The clinical manifestations of children's infratentorial tumors are atypical, the course of diseases is short . It is common to be misdiagnosed.History and physical examination in detail are decisive for diagnosis. MRI and CT are the initial choice in the diagnosis.(4)Operation is the first selection to cure intracranial tumor in childhood.Positive prevention and treat postoperative complications are beneficial to improve the surgical outcome. Reasonable radiotherapy and chemotherapy are the main means of adjuvant therapy.(5) The region compliance of patients with brain tumors is poor. |
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