A Favorable Postoperative Course after Removal of Tumor of the Fourth Ventricle

Samochernykh K.A., Novikov V.Yu.

(Polenov Research Neurosurgical Institute)

Female patient K., born in 1993, was admitted to the Department of Children's Neurosurgery in a severe state. On admission a clinical picture was characterized by hydrocephalus-hypertension-dislocation syndrome, a symptom-complex of the cerebellum lesion, bulbar syndrome, alternating syndrome on the right at the level of the medullaoblongata. The patient was sick during 1.5 months. The first signs of the disease were headache, the syndrome of occlusion of likvor ducts, a progradient course of a pathologic process.

CT and MRI examinations were indicative of a large area, containing pathologic tissue, localized in the fourth ventricle and dislocating the cerebellum in a dorsal direction and the fourth ventricle fundus in a ventral direction. There was transventricular hydrocephalus.

Taking into account marked hydrocephalus-hypertension-dislocation syndrome and a severity of the child's state, urgent ventriculoperitoneostomy was made on November 17, 2000 with applying a system of mean pressure and slow liquor flow. It led to stabilization of the patient's state and regress of manifestations of hydrocephalus-hypertension-dislocation syndrome. However, signs of the cerebellum and stem lesion were persistent. Suboccipital craniotomy and tumor removal were made on November 27, 2000 (Khachatryan V.A., Samochernykh K.A., Kim A.V., Novikov V.Yu.). The patient was in a sitting position. The great foramen margin and the atlas arch were not resected. The tumor had a distinct borderline with the cerebellum and grew from the right half of the inferior trigone of the fourth ventricle fundus (more laterally, than araeae n. vagi) and from the right funicular body. Removal of the tumor residues from the fourth ventricle fundus was not accompanied by hemodynamic disorders.