Khachatryan V.V., Akopova R.Yu.
(Polenov Research Neurosurgical Institute)
Male patient B., born in 1975, suffered from headache, accompanied by vomiting, since he was 5. He was treated for gastritis and followed by a pediatrician during 2 years. Later (November 1982) there appeared cerebellar gait and failing sight. The patient was blind and could not walk since November 20, 1982.
He was admitted to the Polenov Research Neurosurgical Institute on December 21, 1982 in a severe state. A clinical picture was characterized by hydrocephalus-hypertension syndrome, a symptom-complex of the stem and cerebellum lesion. There were engorged disks, blindness, dysphonia, dysarthria, inhibition of pharyngeal and laryngeal reflexes, inhibition of soft palate reflexes, muscular hypotension, ataxia of the trunk and extremities, Brunce syndrome, i.e. hypertensive headache, vomiting, a forced position of the head, rigidity of cervical-occipital muscle, bilateral Babinsky's syndrome. Craniograms showed disjunction of cranial sutures and rentgenologic signs of increased intracranial pressure. Scintigraphy revealed a large pathologic focus of activity along the median line with deviation to the right at the border of the middle and posterior cranial fossa. Ventriculography was indicative of mixed hydrocephalus, occlusion of oral segments of the aqueduct.
The operation was made on December 24, 1982. It consisted in trephination of the posterior cranial fossa, removal of tumor of the fourth ventricle and cerebellum. The tumor was localized in the fourth ventricle and spread to the cerebellar vermis and hemispheres. It grew from the left superior trigone of the rhomboid fossa fundus. A narrow strip of tumor tissue (a length of 30.0 cm, thickness of 0.3 cm and width of 2 cm) was left at the rhomboid fossa fundus. Histologic study revealed astrocytoma.
A postoperative course had no peculiarities. Hypertension and ataxic syndromes regressed. Amaurosis was watched even after the operation. The patient is being followed up by a neurologist (a period of supervision is 18 years). He graduated from the University and works as a lawyer. Today there is amaurosis, atrophy of disks of optic nerves as a result of engorgement, a slightly smoothed down left nasolabial fold. MRI shows a state after suboccipital craniotomy and tumor removal.
To discuss surgical treatment, resulting in a favorable course of the fourth ventricle tumors with initial growth from relatively ineloquent areas and good social adaptation of patients even in case of an advanced stage of the disease.