A stereotactic volumetric resection of the lesion was then performed. The volume of the tumor, based on the contrast-enhancing portions on both CT and MRI, as well as from the area of abnormality on T2-weighted MRI, was digitized for computer targeting. A view of the cortical surface after the trephine craniotomy was performed.A st** electrode placed onto the cortical surface in a direction posterior to the edge of the trephine confirmed the location of sensorimotor cortex by phase reversal.

 

　　The tumor volume can be superimposed onto the field of view of the operating microscope,to assist the surgeon in defining the margins of the tumor. The lesion was dissected away from the surrounding brain tissue at its interface and was removed as a single specimen.                  ,

 

　　The patient's neurologic function postoperatively was unchanged from his preoperative status.

 

　　Pathologic Report

 

　　The tumor was signed out as glioblastoma multiforme arising as a small focus within a lowgrade astrocytoma.  The malignant portion apparently was the contrast-enhancing portion on the preoperative scans. The patient is scheduled to begin external beam radiotherapy followed by chemotherapy.

 

　　Case 8: Choroid plexus papilloma of third ventricle (transcallosal approach)

 

　　三腦室脈絡(luò)叢**狀瘤（經(jīng)胼胝體入路）

 

　　This 8-year-old boy presented in May 1977 with a 3-week history of episodic headache accompanied by vomiting and obtun-dation.  Hyperactive behavior and some difficulties with visual Perception and motor coordination had been noticed from the age 1 or 3 years. Examination by a pedtatrician 2 years earlier had revealed clumsy, slow, and deliberate walking and finger-to-nose ^d rapid alternating movements that were abnormally slow, with noticeable overflow movements to the opposite side. The patient's Verbal Intelligence Quotient (I. Q. ) had been recorded as 112 and his Performance I. Q. had been recorded as 74 (Full Scale, 92). More recently his performance in athletics had been above average? e. g. 9 he was considered to be the best pitcher in his baseball league.

 

　　Physical examination revealed mild papilledema and paralysis of conjugate upward gaze. A CT scan showed very large lateral ventricles and a calcified mass within the 3rd ventricle. A biven-triculo-peritoneal shunt was inserted. Metrizamide ventriculogra-phy demonstrated a papillary mass within the 3rd  ventricle and extruding through the right foramen of Monro.A choroid plexus papilloma was removed through the right foramen of Monro via a 2-cm longitudinal incision in the corpus callosum. The postoperative course was smooth, and the shunt was removed 1 week later.

 

　　A year later the patient was described by his parents as mildly emotionally labile, but he was performing normally in school and was still playing baseball better than his peers. Neurological examination has revealed no deficit. Computerized tomography has shown moderately large ventricles? but he has no clinical evidence of intracramal hypertension.

 

相關(guān)閱讀：神經(jīng)外科英語病例（1）