兒童髓母細胞瘤術后持續性腦積水預測標準的建立及驗證

【摘要】 目的 建立兒童髓母細胞瘤術后持續性腦積水（PPH）的預測標準，以篩選出發生概率較低的患兒，進行精準治療，避免不必要的腫瘤切除術前腦室腹腔分流術，提高患兒術后生活質量。方法 依據加拿大腦積水術前預測標準（mCPPRH），前瞻性納入2019年12月—2023年3月在首都醫科大學附屬北京天壇醫院神經外科小兒病區第一次接受手術治療的24例髓母細胞瘤患兒，術后隨訪以PPH的發生為主要觀察指標。結果 所有患兒均采用聯合手術治療策略（即術中側腦室穿刺Ommaya囊植入+腫瘤切除術），術后隨訪除1例于術后1年腫瘤播散致死亡外，其余患兒均未出現PPH。結論 通過前瞻性入組髓母細胞瘤合并腦積水的患兒，重點關注年齡、腦積水嚴重程度及腫瘤有無播散，進行聯合手術并長期隨訪，本研究初步建立并驗證了兒童髓母細胞瘤PPH的預測標準，較為簡單、實用，有待于后續更大樣本量的臨床驗證。

【關鍵詞】 兒童髓母細胞瘤；術后持續性腦積水；加拿大腦積水術前預測標準；Ommaya囊；聯合手術

【中圖分類號】 R739.41" 【文獻標志碼】 A" 【文章編號】 1672-7770（2025）01-0020-06

Construction and validation of predictive criteria for postoperative persistent hydrocephalus in pediatric medulloblastoma

Abstract： Objective To establish predictive criteria for post-operative persistent hydrocephalus（PPH） following medulloblastoma surgery in children， in order to identify children with a low probability of occurrence for accurate treatment， avoid unnecessary ventricular-peritoneal shunt before tumor resection， and improve the postoperative quality of life for children.Methods According to the modified Canadian Preoperative Prediction Rule for Hydrocephalus（mCPPRH）， a total of 24 children with medulloblastoma who underwent surgery for the first time in the Pediatric Ward of Neurosurgery， Beijing Tiantan Hospital， Capital Medical University from December 2019 to March 2023 were included. The occurrence of PPH was used as the main observation index during postoperative follow-up. Results All children were treated with combined surgical strategy（intraoperative Ommaya reservoir implantation by lateral ventricle puncture + tumor resection）. No PPH occurred in all the children during postoperative follow-up except for 1 patient who died of tumor spread 1 year after surgery. Conclusions Through prospective enrollment of children with medulloblastoma complicated with hydrocephalus， focusing on age， severity of hydrocephalus and metastasis， combined operation and long-term follow-up， the prediction criteria for PPH of pediatric medulloblastoma was preliminarily established and verified， which is relatively simple and practical， and needs to be clinically verified by a larger sample size in the future.

Key words： pediatric medulloblastoma; postoperative persistent hydrocephalus; mCPPRH; Ommaya reservoir; combined surgery

髓母細胞瘤是兒童最常見的惡性實體腫瘤，在兒童中樞神經系統腫瘤中占比接近20%，好發于小腦蚓部，常突出生長于第四腦室，阻礙腦脊液流通導致梗阻性腦積水，也會因腫瘤播散至蛛網膜下腔引起腦脊液吸收障礙產生交通性腦積水［12］，因此約有80%髓母細胞瘤患兒合并腦積水［34］。患兒通常以顱內高壓癥狀為首要就診原因，表現為頭痛、頭暈、嘔吐、嗜睡等。……