Surgical Outcome of Posterior Fossa Space Occupying Lesion: A Critical Analysis
Journal Title: International Journal of Medical Research Professionals - Year 2018, Vol 4, Issue 3
Abstract
Background: Out of all childhood brain tumors, 54-70% arise in posterior fossa as compared to 15-20% in adults. Medulloblastoma, ependymoma, astrocytoma of cerebellum vermian and brainstem more commonly affect children. Metastatic lesion, hemangioblastoma and lymphoma are more common in adults. In India, there are more number of tuberculoma as compared to west. Primary modality of treatment in these patients is surgical without increasing the morbidity and mortality significantly and adjuvant therapy in form of radiotherapy and/or chemotherapy. Aims: The aim of this study is to analyze patients treated with midline posterior fossa tumor in our hospital and compare their incidence, clinical presentation, radiological features and management with existing literature. Methods and Materials: This study was conducted in Department of Neurosurgery, Tertiary Care Hospital, Ahmedabad, India. 40 consecutive cases of midline posterior fossa tumors were selected for this study from August 2007 till January 2018. All patients with primary brain tumor will be evaluated by history, clinical examination (age, sex, GCS Score, neurological deficit, seizure, hydrocephalous, Glasgow outcome score), laboratory and radiological investigations. Patients were operated by craniotomy and tumor removal. Results and Conclusion: Medulloblastoma, cerebellar astrocytoma, ependymoma, haemangioblastoma and brainstem glioma are commonest among midline posterior fossa sol in pediatric age group. Medulloblastoma, cerebellar astrocytoma, ependymoma and brainstem glioma occur most commonly in pediatric patients. Metastasis and meningioma occur commonly in later age group. Tuberculoma, haemangioblastoma and epidermoid cyst are common in younger (11-40) age group. Intra-axial midline tumors present early with signs and symptoms of raised intracranial pressure and truncal ataxia while extra axial tumor present with other symptoms such as headache. CT scan and MRl finding in association with clinical features gives clues to probable pathological diagnosis. Most patients were i.e. 62.5% were having evidence of hydrocephalus. Pre-operative shunt should be carried out in patients with poor general condition poor consciousness level due to increased intracranial pressure with hydrocephalus. Cerebellar mutism is one of the common complication in midline posterior fossa sol and also due to approach in surgery. Post-operative CSF leak, wound infection, and size of bony defect is also more in patient with sub occipital craniectomy. Intraoperative monitoring with EMG, BERA etc. can help in decreasing incidence of cranial nerve and brainstem damage.
Authors and Affiliations
Tushar V. Soni, Sandeep A. Kala
Keywords
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- EP ID EP532031
- DOI 10.21276/ijmrp.2018.4.3.046
- Views 92
- Downloads 0
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