CC BY
12
Norkulov Najmiddin Uralovich, Shodiev A. Sh.,
Samarkand State Medical Institute Samarkand, Republic of Uzbekistan E-mail: dr.najmiddin62@mail.ru
TO THE PECULIARITIES OF DIAGNOSIS AND TREATMENT OF CEREBELLAR TUMORS
Abstract: This study includes data from a comprehensive examination and treatment of 35 (21 women, 14 men) patients, the average age of patients was 30 years (from 3 to 69 years). The results of the treatment of cerebellar tumors depend on the use of modern surgical methods and their radicalism.
Keywords: cerebellar tumors, medulloblastoma, hemisphere, astrocytoma, ependymoma.
Relevance. The relevance of diagnosis and treatment of cerebellar tumors is due to the prevalence of these pathologies, the severity of the course and the lack of effectiveness of common treatment methods. Among neuro-oncological diseases in children, cerebellar tumors range from 70.6% to 73.6%, according to the histological structure of them, medul-loblastomas range from 29.0% to 48.9%, astrocytomas from 32.1% to 36.0%, ependymomas from 1.4% to 18,0% [1; 9].
The severity of prognosis in patients with cerebellar tumors are due to the development of hydrocephalic-hyper-tensive and dislocation syndromes. The development of hydrocephalus during tumor localization in the cerebellum is more common than with other localization and is caused by occlusion of the cerebrospinal fluid [3; 7; 8].
Neuroimaging methods such as computed tomography (CT) and especially magnetic resonance imaging (MRI), which appeared in the 1970 s. and 1980 s, made a major breakthrough in non-invasive studies of the localization and structure of brain tumors, the patterns of their growth and blood supply, relationship with the surrounding tissues, the dynamics of their development [2; 4].
Surgical tactics, if possible, consist in radical removal of the tumor with subsequent recovery of the liquor outflow. With the help of liquor shunting operations, although it is possible to achieve control over hydrocephalus, however,
after these operations, in 70-95% of cases the condition of the patients becomes drainage-dependent and in 1/3 of the patients the development of one or another complication is observed [5; 6].
Studying the results of applying various therapeutic and diagnostic approaches to well-verified clinical material helps determine the effectiveness of existing methods of diagnosis and treatment of cerebellar tumors.
Purpose of the study. The aim of our study was to study the diagnosis and treatment of cerebellar tumors.
Materials and research methods. This study includes data from a comprehensive examination and treatment of 35 (21 women, 14 men) patients. The average age of patients was 30 years (from 3 to 69 years) who were in inpatient treatment in the neurosurgery department of the clinic of Samarkand Medical Institute for cerebellar tumors from 2012 to 2014. All patients underwent a comprehensive examination, including brain CT, (MRI) and contrasted CT and MRI.
The results of the study and their discussion. For the diagnosis of cerebellar tumors, MRI was performed to all 35 (100.0%) patients, CT to 8 (22.8%) patients and contrast imaging of the brain to 9(25.7%) patients. CT and MRI, depending on the structure of the tumor itself, in 14(40.0%) was cystic, in 5(14.3%) solid, in 6(17.1%) cystic-solid and in 10 (28.6%) infiltrative (figure 1).
Figure 1. CT and MRI depending on tumor structure
TO THE PECULIARITIES OF DIAGNOSIS AND TREATMENT OF CEREBELLAR TUMORS
According to localization, in 13(37.0%) it was local- worm, in 8(22.8%) patients in the cerebral-cerebellar angle, ized in hemispheres, in 10(28.5%) patients in the cerebellar in 4(11.4%) patient in the IV-th ventricle (Figure 2).
i\ VËntricie
pontocerebellar a.
US
worm
ÎS.5.
hemispheres
o lo 2ü 3a Figure 2. Tumor localization
40
All patients underwent surgical treatment, the essence of which was as much as possible in the radical removal of the tumor, depending on the operability of the tumor itself, followed by recovery of the liquor outflow.
Depending on the location of the tumor, we used the following prompt access: in 22(62.8%) patients, a midline skin incision and resection of the occipital bone scales, in
13(37.2%) patients, a paramedian skin incision on the left or right, and a resection of the occipital bone on the left, of these, 5 patients (14.3%) had Torkildsen ventriculocystomy surgery in order to normalize liquorodynamics.
Histological examination of these tumors most frequently revealed medulloblastomas (42.9%), followed by astrocytomas (37.1%) and ependymomas in (20.0%) (Figure 3).
Figure 3. Histological structure of cerebellar tumors
It should be noted that out of 35 operated patients, total tumor removal was achieved in 26(74.3%), subtotal removal in 7(20.0%) and biopsy in 2(5.7%) patients.
Postoperative mortality was observed in 6(17.1%) patients, and it dominated after subtotal removal of the tumor (11,4%), and in patients after total removal of the tumor and biopsy, only one case was fatal.
Conclusions:
1. The main methods in the diagnosis of cerebellar tumors are MRI and CT methods, which allow to determine the structure, morphological features, the presence of infiltration, cysts and edema with their qualitative and quantitative assessment.
2. Among cerebellar tumors, cystic (40.0%), solid and infiltrative (by 28.6%), relatively less cystic-solid (17.1%) tumors are more often detected. These tumors are predominantly located in the hemispheres (37.0%) of the worm (28.5%), then in the ponto-cerebellar angle (22.8%) and the IVth ventricle (11.4%).
3. According to the histological structure, medulloblastomas prevail among cerebellar tumors (42.9%), followed by astrocytomas (37.1%) and ependymomas (20.0%). The results of treatment of cerebellar tumors depend on the use of modern surgical methods and their radicalism.
References:
1. Alikhodzhaeva G. A. Surgical treatment of cerebellar and IV ventricular tumors in children // Neurosurgery. - No. 2. 1999.- P. 17-19.
2. Ananyeva I. I., Malkarov M. S., Korsakova N. A., Balkonov A. S., Dorofeev A. E., Kachkoe I. A., Suchkov S. V. Glial brain tumors: modern aspects of classification and the basis of genetic predisposition // Archives of Pathology. 2007.- V. 69.-No. 1.- P. 54-60.
3. Gorelyshev S. K. Tumors of the chiasm and bottom of the third ventricle: Avtoref.dis. ... Dr. med sciences.- M., 2004.
4. Kim A. V. Diagnosis and treatment of hydrocephalic-hypertensive syndrome in children with tumors of the posterior cranial fossa, Diss. Candidate of Medical Sciences, 2004.
5. Konovalov A. N., Kornienko V. N., Ozerova V. I., Pronin I. N. Neurorenthenology of childhood.- M: Antidor 2001.
6. Scherbenko O. I. Ependymomas of the brain. The current state of the issue. Literature Review // Bulletin of the Russian Scientific Center for X-ray Radiology of the Federal Agency for High-Tech Medical Aid. 2012.- T. 2.- No. 12.- P. 14-14.
7. Schigolev Yu. S., Gizatullin Sh. Kh., Sidorenko V. V., Smorodsky S. G. Metastatic tumors of the nervous system // Military Medical Journal. 2006.- T. 327.- No. 6.- P. 30-34.
8. Bruns D. E., Ashwood E. R., Burtis C. A. (eds.). Fundamentals of Molecular Diagnostics. St Louis: Saunders 2007.
9. Ling Weiwang, Cheng Ying Shiau, Wen Yuh Chung. Gamma Knife surgery for low-grade astrocytomas: 10-year experience evaluation. J Neurosurg 2006; 105: Suppl: 127-132.
10. Louis D. N., Ohgaki H., Wiestler O. D., Cavenee W. K., Burger P. C.,Jouvet A., Scheithauer B. W., Kleihues P. The 2007. WHO Classification of the Central Nervous System. Acta Neuropathol 2007; 114 (2): 97-109.
