中英临床推理儿童期松果体母细胞瘤治疗

A13-year-oldgirlpresentedacutelywithanepisodeofheadacheandsignsofelevatedintracranialpressurefromapinealglandtumorcausingobstructivehydrocephalus.Afteranendoscopicthirdventriculostomyandpinealglandbiopsy,shewasdiagnosedwithpineoblastoma.Shewastreatedwithsurgicalresection,craniospinalradiotherapy,andsubsequentchemo-therapy.BrainMRIswereperformedevery3monthsaftersurgeryandremainedstablewithnonewlesionsorsignsofresidualtumor.However,afollow-upbrainMRIperformed6monthsafterchemotherapyshowedsomesmallwhitematternonenhancinglesionsinsupratentorialsubcorticalareasandwithinthecordatC7.Shehadnoneurologicsymptomsatthattimeandthewhitematterlesionsimprovedoverthenext3months.

患者13岁女性，因松果体瘤引起梗阻性脑积水，出现急性发作性头痛及颅内压增高症状。经内镜下第三脑室造瘘术及松果腺组织活检后，诊断为：松果体母细胞瘤。患者接受外科手术切除瘤体、颅脊柱放疗并且之后又进行了化疗治疗。手术后3个月病情稳定，颅脑MRI显示无新病灶或肿瘤残留的迹象。化疗6个月后随访MRI显示幕上皮质区以及颈髓C7水平出现白质无强化的损害，此时患者并没有神经系统症状。三个月后白质损害加重。

However,10monthslater,shedevelopedacuteweaknessofherleftarmandlegandblurryvision.Herneurologicexaminationconfirmedleftopticneuritisandmoderatelefthemiparesis.Routinelaboratoriesdidnotshowanyabnormalities.AnewbrainMRIshowednewandenhancinglesionsinthebrainandspinalcord,includingcerebellarhemispheres,leftcerebellarpeduncle,subcorticalwhitematter,leftopticnerve,andmultilevel(thoracicandlumbar)intramedullaryspinalcordlesions(figure,AandB).Someofthemwereroundandhada

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