CC BY
3TO THE PECULIARITIES OF THE COURSE OF CEREBELLAR TUMORS
Juraev A.M.
Juraev Anvar Mamatmuradovich - Assistant of the Neurosurgery, DEPARTMENT OF NEUROSURGERY, SAMARKAND STATE MEDICAL UNIVERSITY, SAMARKAND, REPUBLIC OF UZBEKISTAN
The urgency of the problem. In the structure of tumors of the posterior cranial fossa, neoplasms of the cerebellum occupy about 70.6-73.6% [1]. Tumors of the cerebellum can be either benign (astrocytomas), characterized by slow growth, or malignant, infiltratively growing (medulloblastomas). Medulloblastomas account for about 20.0% of all primary tumors of the central nervous system in children. In the United States, 2 new cases of medulloblastomas are detected per 1 million white population annually, 1 case per 1 million blacks, and 1,700 sick children are diagnosed annually under the age of 18 [4]. In adults, they are extremely rare - annually 5-6 new cases per 10 million [5, 6]. Every year, 1.4 per 100,000 children under the age of 16 fall ill with cerebellar tumors in Russia, which is approximately 450 new cases per year [2].
In the structure of morbidity, 2 peaks are determined - from 3 to 4 and from 8 to 9 years [7]. The syndrome of intracranial hypertension and hydrocephalus are clinically manifested by headache, often forced head position, nausea, and vomiting. Disorders of consciousness, convulsive seizures are possible [8].
Slow tumor growth, location in close proximity to CSF-containing spaces create good conditions for the development of compensatory mechanisms of the brain, due to which clinical manifestations occur at later stages of the disease, when the tumor reaches a large size and presents certain difficulties for surgical treatment [3] .
The defeat of the cerebellum, especially its worm, causes a violation of the statics of the body - the ability to maintain a stable position of its center of gravity, which ensures stability. When this function is disturbed, static ataxia occurs. The patient becomes unstable, therefore, in a standing position, he tends to spread his legs wide apart, balances his hands. With an isolated lesion of the hemispheres, coordination disorders are observed, accompanied by instability, swaying of the body, and a fall [4].
Until now, and quite often, patients with such pathologies receive unqualified treatment for a long time from pediatricians, infectious disease specialists, neurologists, and are hospitalized in neurosurgical departments in neglected, decompensated states.
It is pertinent to note that despite the presence of numerous works covering the course of treatment methods for cerebellar tumors, clinical symptoms, especially early signs, are not sufficiently represented in them, and therefore, we consider it expedient to conduct new studies in this direction.
Purpose of the study. The aim of our study was to study the features of the clinical course of cerebellar tumors.
Materials and research methods. The present study included data from clinical and neurological examinations of 35 patients (21 women, 14 men). The average age of the patients was 30 years (corresponding variation from 3 to 69 years), who were hospitalized in the neurosurgery department of the clinic of the Samarkand Medical Institute (SamMI) for cerebellar tumors from 2012 to 2014. It included 10 (28.5%) patients with tumors located in the cerebellar vermis, 8 (22.8%) patients in the cerebellopontine angle, 8 (22.8%) patients in the left hemisphere, 5 (14.2 %) of patients in the right hemisphere, 4 (11.4%) patients in the IV ventricle. All patients underwent a comprehensive examination, including computed tomography (CT) and magnetic resonance imaging (MRI).
Results of the study and their discussion. The clinical picture of cerebellar tumors was characterized by a gradual progression of cerebellar and cerebellar-vestibular symptoms associated with local lesions of the cerebellar tissue, stem syndrome, depending on the compression of the trunk at the level of the posterior cranial fossa, as well as dysfunction of the nerves and a syndrome of increased intracranial pressure due to ventricular hydrocephalus.
An early symptom of the disease was headache, which was often accompanied by vomiting. The early symptoms of cerebellar tumors also include impaired coordination, nystagmus, and muscle hypotension.
Gradual progression of intracranial pressure was accompanied by vomiting in 28 patients (80.0%), it was often observed simultaneously with dizziness in 9 patients (25.7%), forced position of the head and trunk.
The most common symptom in cerebellar tumors was muscle hypotension in the extremities, which was observed in 34 patients (97.1%). Violation of the posture and position was detected in 32 patients (91.4%), which manifested itself with a fixed position of the head and tilting it back or tilting forward.
Cerebellar tumors were characterized by dysfunctions of the cranial nerves (80.0%), among oculomotor disorders the most distinct were quadrigeminal paresis and gaze paralysis observed in 13 patients (37.2%), indicating progression of compression trunk. Spontaneous nystagmus was noted in 29 patients (82.8%), paresis of the abducens nerve in 3 patients (8.6%), facial paresis in 10 patients (28.6%), auditory and glossopharyngeal paresis in 1 patient (2.9% ), related to late symptoms, while paresis of the soft palate was detected mainly on one side.
Life-threatening in patients with cerebellar tumors was the syndrome of descent of the cerebellar tonsil and its incarceration in the foramen magnum. The symptoms of an occlusive attack were caused by a rapidly increasing delay in the outflow of cerebrospinal fluid from the ventricular system as a result of complete (or almost complete) or temporary obliteration (blockage) of the outflow tract, observed in 19 patients (54.3%). Prolonged hypertension contributed to the occurrence of occlusive hydrocephalus, which was observed in 16 patients (45.7%). Occlusive hydrocephalus was also accompanied by intraventricular hypertension and compression of the brainstem.
Conclusions
An early symptom of cerebellar tumors is headache, which is accompanied by vomiting, incoordination,
nystagmus, and muscle hypotension. The progression of cerebral symptoms depends on either complete partial
blockade of the CSF circulation pathways, occlusion of the ventricular system.
References
1. Ravshanov D.M. Some Features of the Clinical Course of Parasagittal Meningiomas of the Brain, Asian Journal of Case Reports in Medicine and Health, P. 19-23
2. Ravshanov D.M. "Frequency and Peculiarities of Localisation of Parasagittal Meningiomas of the Cerebral Hemispheres."International Journal of Health Sciences, no. II, 26 Apr. 2022, pp. 6035-6041,
doi: 10.53730/ijhs.v6nS2.6566
3. Davron Mavlonovich Ravshanov. Optimization of the Results of Surgical Treatment of Parasagittal Meningiomas of the Brain. TJMS 2022. 10. P. 48-51.
4. Norkulov N. U., Shodiev A.Sh. & Ravshanov D.M. Determination of the efficacy of the use of nootropes in the treatment of brain concusion in the acute period.
5. Mamadaliev A.M., AlievM.A. The Importance of the Duration Disorders of Consciousness to Prognosis of the Outcome of Cranio-Cerebral Trauma //Proceedings of XIV WFNS Congress, Boston, USA. - 2009.
6. Aliev M.A., Mamadaliev A.M. Study of Efficacy of Endocystal Ozonetherapy in the Operative Treatment of Posttraumatic Arachnoidal Cysts //Proceedings of XV WFNS Congress,(FA0754)., Seoul, Korea. - 2013.
7. Mamadaliev A.M., Shakhnovich A.R., Abakumova L.Ia., et al. [Surgical treatment of patients with cranio-cerebral trauma and the role of neurological symptoms in the prognosis of its outcomes]. Vestnik Khirurgii Imeni I. I. Grekova. 1989 May; 142(5). P. 68-72. PMID: 2800228.
8. Aliev M.A., Mamadaliev A.M., Mamadalieva S.A. The effectiveness of endolumbal insufflation of ozone and pyracetam in the treatment of posttraumatic cerebral arachnoiditis // МНИЖ. 2015. №10-4 (41).
9. Aliev M.A., Mamadaliev A.M. Macronutrient composition of biological media in patients with post-traumatic cerebral arachnoiditis //Proceedings of VIII All-Russian Scientific-Practical Conference" Analytical reliability and diagnostic value of laboratory medicine," Journal of Laboratory. 2013. №. 1. P. 23.
10. Bakhritdinov B.R, Aliev M.A, & Mardieva G.M. (2022). MULTIVOXEL MAGNETIC RESONANCE SPECTROSCOPY IN THE DIAGNOSIS OF BRAIN TUMORS. World Bulletin of Public Health, 8. P. 149156.
11. Aliev M.A., Mamadaliev A.M., Mamadalieva S.A. The effectiveness of endolumbal insufflation of ozone and pyracetam in the treatment of posttraumatic cerebral arachnoiditis // МНИЖ. 2015. №10-4 (41).
12. Dyusembekov E, Akhanov G., Aliev M., Uteuliyev Y., Saktapov A. [THE ANALYSIS OF MORTALITY CAUSES IN PATIENTS WITH SEVERE TRAUMATIC BRAIN INJURY IN ALMATY]. Georgian Medical News. 2018 Dec (285). P. 17-20. PMID: 30702063.
13. Mamadaliev A.M., Shodiev, A.S., Aliev M.A., & Nabiev A.A. (2011). By studying the composition of macronutrients are in biological media in post-traumatic cerebral arachnoiditis. In Bersnev V.P. (Eds.), Abstracts of 10th Russian Scientific-Practical Conference of "Polenov reading's", St. Petersburg, Russian Federation.
14. Aliev M.A., Akhmetov K.K., Chentsov V.I., Gorgots O.V. [Microsurgical reconstructive-rehabilitative operations in traumatic lesions of the peripheral nerves]. Zhurnal Voprosy Neirokhirurgii Imeni N. N. Burdenko. 1989 Nov-Dec (6). P. 15-16. PMID: 2629431.
15. Mamadaliev A.M., et al. "Research Of Effectiveness of Different Sposobov Plastics Posttraumatic Defects Svoda Cherepa." JournalNX, 2020. P. 133-139.
16. Yuldashev Sh.S., Shodiev A.Sh., Mamadaliev A.M., КОМБ1НОВАНИЙ ТРАНСПЛАНТАТ ТА ЙОГО ЗНАЧЕННЯ В Х1РУРПЧНОМУ Л1КУВАНН1 СТАШЛЬНИХ ПОШКОДЖЕНЬ Т1Л ГРУДНОГО ТА ПОПЕРЕКОВОГО В1ДД1Л1В ХРЕБТА, Клшчна анатомш та оперативна х1рурпя - Т. 16, № 4 - 2017, https://doi.org/10.24061/1727-0847.16.4.2017.94
17. Norkulov N. U., Shodiev A.Sh. To the peculiarities of diagnosis and treatment of cerebellar tumors // European science review. 2018. №11-12.
18.Мамадалиев А.М. К Гистологическим особенностям опухолей головного мозга//Матер. Всеросс. НПК «Поленовские чтения». СПб. 2010. С.266
19. Norkulov N. U., Mamadaliev A.M., Shodiev A.Sh. The importance of neurological symptoms of mild traumatic brain injury for clinical and forensic assessment of patients. Vrach-aspirant. 2012. 4.2(53). P. 245-249. (In Russ.).
20. Мамадалиев A.M., Алиев М.А. Study of results of combined treatment of glial brain tumors. World Federation Neurosurgery Societies Special World Congress Proceedings, The Last Interim Meeting, 9-12 September, 2019. Beijing, China. Abstract ID: 1265672, E-Poster: EP-0099. https://wfns2019.medmeeting.org /V2/userEN/contributeview/1265672.
21. Мамадалиев A.M., Алиев M.A., Саидов К.Ж. The Research Of Different Methods Efficiency Of Posttraumatic Valve Defects Plasty. European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 3, Pages 4453-4459. London, E13 9PJ, United Kingdom. https://ejmcm.com/ article_4676.html. (Scopus).
22. Алиев М.А., Мамадалиев А.М. Study Of Clinical And Neurological Changes In Patients With Different
Outcomes Of Traumatic Brain Injury After Endolumbar And Intracystal Ozonotherapy. European Journal of Molecular & Clinical Medicine. ISSN 2515-8260 Volume 07, Issue 03, 2020. P. 1510-1517. London, E13 9PJ, United Kingdom. https://ejmcm.com /article_3410.html. (Scopus). 23.АлиевМ.А., Мамадалиев А.М., Мамадалиева С.А. Research Of Changes Of Essential Elements Composition In The Cerebrospinal Fluid In Patients With Outcomes Of Traumatic Brain Injury Before And After Endolumbar Ozonotherapy. European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 3, P. 1559-1570. London, E13 9PJ, United Kingdom. https://ejmcm.com/ article_3419.html. (Scopus).
1.
