目的 探讨儿童脑膜瘤的特性和诊疗进展,为治疗提供新的视点.方法 回顾性分析清华大学玉泉医院神经外科2014年1月—2022年4月收治的9例经手术病理证实为脑膜瘤患儿的临床资料.结果 患儿最常见的临床症状是偏瘫、呕吐.所有患儿术前均行头颅CT、MRI检查,脑组织标本均经病理诊断,其中包括2例内皮型脑膜瘤,2例纤维型脑膜瘤,1例砂粒型脑膜瘤,1例血管瘤型脑膜瘤,1例横纹肌样脑膜瘤,1例间变型脑膜瘤,1例非典型脑膜瘤.9例患者中7例全切除,2例次全切除(其中Simpson Ⅰ级2例,Ⅱ级3例,Ⅲ级2例,Ⅳ级2例),术后无手术相关偏瘫或其他肢体功能障碍,无术后颅内血肿.到目前为止,其中2例复发,且均为WHO Ⅲ级脑膜瘤.结论 相比于成人,儿童脑膜瘤发病率低,可能与放射治疗和神经纤维瘤病2型关系密切,病理恶性度高,手术全切除是治疗儿童脑膜瘤的首选方法,对于3岁以上未能全切患儿应当考虑术后放疗,可延长生存期、降低肿瘤复发率.

Objective To investigate the indication and significance of preoperative chemotherapy for pediatric patients with brain malignant tumors. Methods and Results The clinical data of 9 pediatric patients with brain malignant tumors who were admitted to Department of Neurosurgery, Tsinghua University Yuquan Hospital from January 2017 to August 2019 were retrospectively analyzed. The patients were 6 males and 3 females, aged from 1.50 months to 6 years. Among the 9 cases, 5 cases were located in the pineal region, one case in the third ventricle, one case in the frontotemporal and the basal ganglia region and 2 cases in the fourth ventricle. The preoperative clinical diagnosis of the 9 patients included 5 cases of germ cell tumor, 2 cases of medulloblastoma, one case of pineal blastoma and one case of embryonal tumor. Before the chemotherapy, 6 patients were treated with ventriculo⁃peritoneat shunt, 2 patients with ventricular puncture and external drainage, and one patient with endoscopic third ventriculostomy. Before surgery, 2 cases were given carboplatin+etoposide regimen, 4 cases were given cisplatin+etoposide regimen, one case was given carboplatin+etoposide+isophoramide regimen, and 2 cases were given cisplatin+etoposide+isophoramide regimen. 6 patients received one cycle of chemotherapy before tumor resection, 2 patients received 2 cycles and one patient received 3 cycles. All of the patients received tumor resection after 1-3 cycles of chemotherapy. The following treatments were depended on the pathological results. After preoperative chemotherapy, tumors' volume decreased in 7 cases while increased in one case. Additionally, there was one case of tumor apoplexy. The blood supply of tumors of all the 9 patients was not abundant. Among the 9 cases, total removal was achieved in 8 cases and subtotal in one case. The pathological results revealed 3 germ cell tumors, 2 pineoblastomas, 2 medulloblastomas, one diffuse midline glioma, and one atypical teratomoid/rhabdomyoid tumor (AT/RT). The 9 patients were followed up from 8 to 38 months (mean 18 months). Three patients died of tumor recurrence and there were no tumor recurrences in the other 6 patients. Conclusions Preoperative chemotherapy may be considered for children with brain malignant tumors which are clinically sensitive to chemotherapy at high risk of surgery. Preoperative chemotherapy for brain tumors in infants and young children was effective in reduction of tumor volume and vascularity, which significantly facilitated maximal tumor resection.

Objective To explore the differences of brain cognitive function and behavior in children with craniopharyngioma during perioperative period. Methods The clinical data of 19 patients with craniopharyngioma were retrospectively enrolled who underwent craniotomy at Department of Neurosurgery, Tsinghua University Yuquan Hospital from February 2015 to February 2017. The mean age of patients was 9. 10 ± 3. 53 (6 -15) years old. Twelve cases were primary tumors and 7 were recurrent tumors. Craniotomy was conducted for tumor resection in all patients. Fourteen cases were treated through frontal coronal incision approach, 3 through corpus callosum-transparent compartment-dome approach and 2 through small incision of pterional approach. The intelligence test was performed using the fourth edition of the Wechsler Intelligence Test Scale before and after surgery. The Conners Child Behavior Scale ( for parents) was used for behavioral testing. The cognitive function and behavioral changes of the brain in 19 children with craniopharyngioma before and 2 weeks after operation were compared. Results Among the 19 children with craniopharyngiomas, total tumor resection was achieved in 17 cases and subtotal resection in 2. There was no operative death. The preoperative and postoperative total IQ (intelligence quotient) scores (101.68 ±18. 50 vs. 103. 05 ± 15. 67), verbal comprehension indexes(98. 00 ± 13. 51 vs. 101. 00 ± 17. 07), perceptual reasoning indexes (94. 11 ± 12. 60 vs. 95. 26 ± 15. 05), working memory indexes (87. 00 ± 14. 15 vs. 92. 16 ± 19. 12), processing speed indexes (92. 95 ± 17. 17 vs. 95. 47 ± 16. 91) had no significant difference (all P >0. 05). There were no significant differences in behavior scores of the children before and 2 weeks after operation (all P>0. 05). Conclusion There seems to be no significant decrease in postoperative intelligence and behavioral level in children with craniopharyngioma. It shows that the surgical resection itself would not cause damage to the cognitive function of the child.

The aim of the current study was to investigate the operation skills and complications associated with skull defect repair using biomimetic bone（nano-hap/collagen composites）. Clinical data from 45 patients with skull defects who underwent cranioplasty with biomimetic bone from January 2014 to January 2017 were retrospectively analyzed.All patients participated in follow-up visits from 8 months to 3 years postoperatively. Cranioplasties were successful in all 45 patients,but 17 patients（20 cases） presented various complications, including subcutaneous hydrops（14 cases）, biomimetic bone fixation loosening（4 cases）, wound indolence（1 case）, and biomimetic bone fragmentation（1 case）. Cranioplasty complications in surgeries using biomimetic bone are more common in children than in adults.Understanding the physicochemical properties of biomimetic bone and the normal developmental process in children, as well as mastering the appropriate surgical skills and implementing the effective preventive measures are all ways to reduce and control the incidence of complications associated with biomimetic bone cranioplasty.

Objective To evaluate the clinical results of repairing skull defects with biomimetic bone (nano-hap/collagen composites, NHACs) in children. Methods Thirteen children with skull defects were treated with NHACs in our hospital. The NHACs molded with the help of a 3D printer were used in the operations. Results All 13 operations were successful, and patients recovered without infection. Only one patient suffered from subcutaneous hydrops post-operation. The implanted NHACs remained fixed well after 1 year, and their CT HU values raised gradually. Skull shapes of children developed normally. Recovery of neurological and cognitive function was significant. Conclusions NHAC, chosen to repair skull defects in children, can coexist with normal skull and reduce the negative effects on growth and development. NHAC could be a good choice for children with skull defects.