POSTERİOR FOSSA TÜMÖRLERİ: CERRAHİ DENEYİM 47 OLGU

Öz

Amaç: Bu çalışmada kliniğimizde ameliyat edilen posterior fossa tümörlerinin değerlendirilmesi amaçlandı.

Yöntemler: Çalışmada 2014-2018 yılları arasında kliniğimiz de ameliyat edilen 47 posterior fossa tümörlü hasta şikayet, yaş, cinsiyet, tümör patolojisi ve cerrahi komplikasyonlar ile birlikte retrospektif olarak incelendi.

Bulgular: Hastaların 26’sı kadın 21’i erkektir. Hastaların 8 tanesi çocukluk yaş grubunda 39 tanesi erişkin yaş grubundadır. Çocukluklarda ortalama yaş 7,7, erişkinlerde ortalama yaş 48,8'dir. Baş ağrısı %40,4 ile en sık şikâyetti. Çocuklarda en sık medulloblastom görülürken, erişkinlerde ekstraaksiyel olarak menenjiom, intraaksiyel olarak metastazlar ve primer intraaksiyel olarak da hemanjioblastom görülmekteydi. Beyin sapı yaralanması ve enfarktı, venöz sinüs yaralanması, hidrosefali, beyin omurilik sıvısı (BOS) fistülü, kranial sinir yaralanması görülen komplikasyonlardı.

Sonuç: Posterior fossa tümör cerrahisinde sağ kalım üzerine en etkili faktör cerrahi rezeksiyonun ne kadar yapıldığıdır ancak uzun yaşam kadar sekelsiz yaşamın da önemli olduğu düşünüldüğünde gelişen anjiografi teknikleri, radyoterapi ve radyocerrahi ile birlikte preoperatif ve postoperatif dönemde bu seçeneklerin varlığının göz önünde bulundurulmasının agresif cerrahilerin önüne geçebileceğini düşünmekteyiz.

Anahtar Kelimeler

• Posterior Fossa Tümörleri,Cerrahi Deneyim

Kaynakça

1. Johnson KJ, Cullen J, Barnholtz-Sloan JS, Ostrom QT, Langer CE, Turner MC, et al.Childhood brain tumor epidemiology: a brain tumor epidemiology consortium review.Cancer Epidemiol Biomarkers Prev. 2014 Dec;23(12):2716-36.
2. Wilne S, Collier J, Kennedy C, Koller K, Grundy R, Walker D. Presentation of childhood CNS tumours: a systematic review and meta-analysis. Lancet Oncol. 2007 Aug;8(8):685-95.
3. Sönmez MA, Tekiner A, Bayar MA, Yılmaz A. Posterior Fossa İntraaksiyel Tümörlerinin Retrospektif İncelenmesi Kocatepe Tıp Derg. 2012;13:133–7.
4. Lin CT, Riva-Cambrin JK. Management of posterior fossa tumors and hydrocephalus in children: a review. Child’s Nerv Syst. 2015;31(10):1781–9.
5. Ostrom QT, Gittleman H, Liao P, Vecchione-Koval T, Wolinsky Y, Kruchko C, et al.CBTRUS Statistical Report: Primary brain and other central nervous system tumors diagnosed in the United States in 2010-2014. Neuro Oncol. 2017 Nov 6;19(suppl_5):v1-v88.
6. Taylor MD, Northcott PA, Korshunov A, Remke M, Cho Y-J, Clifford SC, et al. Molecular subgroups of medulloblastoma: the current consensus. Acta Neuropathol. 2012 Apr;123(4):465–72.
7. Ellison DW, Kocak M, Dalton J, Megahed H, Lusher ME, Ryan SL, et al. Definition of Disease-Risk Stratification Groups in Childhood Medulloblastoma Using Combined Clinical, Pathologic, and Molecular Variables. J Clin Oncol. 2011 Apr 10;29(11):1400–7.
8. Grossman R, Ram Z. Posterior Fossa Intra-Axial Tumors in Adults. World Neurosurg. 2016 Apr;88:140-5.

9. Cage TA, Clark AJ, Aranda D, Gupta N, Sun PP, Parsa AT, et al. A systematic review of treatment outcomes in pediatric patients with intracranial ependymomas. J Neurosurg Pediatr. 2013 Jun;11(6):673–81.
10. Louis DN, Perry A, Reifenberger G, von Deimling A, Figarella-Branger D, Cavenee WK, et al. The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary.Acta Neuropathol. 2016 Jun;131(6):803-20.
11. Constans JP, Meder F, Maiuri F, Donzelli R, Spaziante R, de Divitiis E. Posterior fossa hemangioblastomas. Surg Neurol. 1986 Mar;25(3):269–75.
12. Zülch KJ. Their Biology and Pathology. Brain Tumors. 3rd edition Springer- Verlag, Berlin Heidelberg, 1986:228-247
13. Roonprapunt C, Silvera VM, Setton A, Freed D, Epstein FJ, Jallo GI. Surgical management of isolated hemangioblastomas of the spinal cord. Neurosurgery. 2001Aug;49(2):321-7; discussion 327-8.
14. Richard S, Campello C, Taillandier L, Parker F, Resche F. Haemangioblastoma of the central nervous system in von Hippel-Lindau disease. French VHL Study Group. J Intern Med. 1998 Jun;243(6):547–53.
15. Kuharic M, Jankovic D, Splavski B, Boop FA, Arnautovic KI. Hemangioblastomas of the Posterior Cranial Fossa in Adults: Demographics, Clinical, Morphologic, Pathologic, Surgical Features, and Outcomes. A Systematic Review. World Neurosurg. 2018 Feb;110:e1049–62.
16. Richard S, David P, Marsot-Dupuch K, Giraud S, Béroud C, Resche F. Central nervous system hemangioblastomas, endolymphatic sac tumors, and von Hippel-Lindau disease. Neurosurg Rev. 2000 Apr 14 [cited 2018 Sep 29];23(1):1–22.
17. Jagannathan J, Lonser RR, Smith R, DeVroom HL, Oldfield EH. Surgical management of cerebellar hemangioblastomas in patients with von Hippel–Lindau disease. J Neurosurg. 2008 Feb;108(2):210–22.
18. Lonser RR, Vortmeyer AO, Butman JA, Glasker S, Finn MA, Ammerman JM, et al. Edema is a precursor to central nervous system peritumoral cyst formation. Ann Neurol. 2005 Sep 1;58(3):392–9.
19. Lee SR, Sanches J, Mark AS, Dillon WP, Norman D, Newton TH. Posterior fossa hemangioblastomas: MR imaging. Radiology. 1989 May 1;171(2):463–8.
20. Pan J, Jabarkheel R, Huang Y, Ho A, Chang SD. Stereotactic radiosurgery for central nervous system hemangioblastoma: systematic review and meta-analysis. J Neurooncol. 2018 Mar;137(1):11-22. doi: 10.1007/s11060-017-2697-0.
21. Davis FG, McCarthy BJ. Epidemiology of brain tumors. Curr Opin Neurol. 2000 Dec;13(6):635–40.
22. Burkhard C, Di Patre PL, Schüler D, Schüler G, Yaşargil MG, Yonekawa Y, Lütolf UM, Kleihues P, Ohgaki H. A population-based study of the incidence and survival rates in patients with pilocytic astrocytoma. J Neurosurg. 2003 Jun;98(6):1170-4.
23. Fernandez C, Figarella-Branger D, Girard N, Bouvier-Labit C, Gouvernet J, Paz Paredes A, et al. Pilocytic astrocytomas in children: prognostic factors--a retrospective study of 80 cases. Neurosurgery. 2003 Sep;53(3):544-53; discussion 554-5.
24. Rodriguez FJ, Scheithauer BW, Burger PC, Jenkins S, Giannini C. Anaplasia in Pilocytic Astrocytoma Predicts Aggressive Behavior. Am J Surg Pathol. 2010 Feb;34(2):147–60.
25. Malik A, Deb P, Sharma MC, Sarkar C. Neuropathological spectrum of pilocytic astrocytoma: an Indian series of 120 cases. Pathol Oncol Res. 2006;12(3):164–71.
26. Ishkanian A, Laperriere NJ, Xu W, Millar B-A, Payne D, Mason W, et al. Upfront observation versus radiation for adult pilocytic astrocytoma. Cancer. 2011 Sep 1;117(17):4070–9.
27. Adams H, Chaichana KL, Avendanõ J, Liu B, Raza SM, Quinõnes-Hinojosa A. Adult Cerebellar Glioblastoma: Understanding Survival and Prognostic Factors Using a Population-Based Database from 1973 to 2009 NIH Public Access. World Neurosurg. 2013;80(6):237–43.
28. Chaichana KL, Rao K, Gadkaree S, Dangelmajer S, Bettegowda C, Rigamonti D, et al. Factors associated with survival and recurrence for patients undergoing surgery of cerebellar metastases. Neurol Res. 2014 Jan;36(1):13-25.
29. Delattre JY, Krol G, Thaler HT, Posner JB. Distribution of brain metastases. Arch Neurol. 1988 Jul;45(7):741–4.
30. deSouza CE, deSouza R, da Costa S, Sperling N, Yoon TH, Abdelhamid MM, et al. Cerebellopontine angle epidermoid cysts: a report on 30 cases. J Neurol Neurosurg Psychiatry. 1989 Aug;52(8):986-90.
31. Ahmed I, Auguste KI, Vachhrajani S, Dirks PB, Drake JM, Rutka JT. Neurosurgical management of intracranial epidermoid tumors in children. J Neurosurg Pediatr. 2009 Aug;4(2):91–6.
32. Yaşargil MG, Abernathey CD, Sarioglu AC. Microneurosurgical treatment of intracranial dermoid and epidermoid tumors. Neurosurgery. 1989 Apr;24(4):561–7.
33. Campbell E, Whitfield RD. Posterior Fossa Meningiomas. J Neurosurg . 1948 Mar;5(2):131–53.
34. Sekhar LN, Wright DC, Richardson R, Monacci W. Petroclival and foramen magnum meningiomas: surgical approaches and pitfalls. J Neurooncol. 1996 Sep;29(3):249–59.
35. Castellano F, Ruggıero G. Meningiomas of the posterior fossa. Acta Radiol Suppl. 1953;104:1–177.
36. Desgeorges M, Sterkers O. [Anatomo-radiological classification of meningioma of the posterior skull base]. Neurochirurgie. 1994;40(5):273-95.