third ventricle tumor
Introduction
Introduction to the third ventricle tumor The third ventricle is located between the thalamus on both sides. It is a long and longitudinal longitudinal fissure with a choroid plexus and an internal cerebral vein at the top, an optic chiasm at the bottom, a funnel, a gray nodule, a papillary body and a hypothalamus, and a third ventricle. The interventricular space communicates with the left and right lateral ventricles, and is connected to the fourth ventricle through the midbrain aqueduct. The third ventricle receives cerebrospinal fluid from the lateral ventricle, and adds cerebrospinal fluid produced by the choroid of the third ventricle to the fourth ventricle through the midbrain aqueduct. The third ventricle tumor refers to two parts of the tumor that originate in the third ventricle or protrude from the third ventricle into the third ventricle. The primary tumors in the third ventricle are gliomas, teratomas, cholesteatomas, and gelatinous cysts. Its incidence rate accounts for about 3% of intracranial tumors, more common in children and young people, more men than women. Because the tumors here are more likely to block the cerebrospinal fluid circulation pathway, it often leads to an increase in intracranial pressure, which is also the reason for the patient's visit. Tumors that protrude from the third ventricle into the third ventricle, in addition to the increased intracranial pressure caused by obstructing the cerebrospinal fluid circulation pathway, also have focal symptoms and signs resulting from the invasion of the brain tissue at the primary site and their unique features. X-ray signs. basic knowledge The proportion of sickness: 0.01% Susceptible people: no specific people Mode of infection: non-infectious Complications: loss of libido, irregular menstruation, precocious puberty, epilepsy
Cause
Third ventricle tumor cause
Congenital factors (35%)
Proto-oncogene activation, tumor suppressor gene dysfunction, DNA mismatch repair gene deletion causes DNA damage not to be repaired in time, accumulates mutations in proto-oncogenes and tumor suppressor genes, and genetic abnormalities that regulate cell entry into programmed cell death Tumors occur, after the tumor occurs, the third ventricle protrudes into the third ventricle or the third ventricle is the third ventricle tumor.
Physical and chemical factors (45%)
Polycyclic aromatic hydrocarbons, aromatic amines and amino azo dyes, nitrosamines, mycotoxins, alkylating agents and acylating agents, etc., these carcinogenic chemicals can induce tumors. In addition, ionizing radiation, heat radiation, some metals, RNA tumorigenic viruses, and DNA tumorigenic viruses can induce tumorigenesis.
Prevention
Third ventricle tumor prevention
1. The daily diet includes a variety of vegetables and fruits, proteins, etc., to enhance resistance.
2. Exercise in moderation to enhance immunity.
3. Avoid contact with radiation during daily life and work, and stimulate the carcinogenic chemical drugs. If necessary, take protective measures.
4. Limit the intake of alcoholic beverages.
5. Limit the intake of marinated, smoked, and nitrite-containing foods.
Complication
Third ventricle tumor complications Complications, libido, irregular menstruation, precocious epilepsy
When the tumor invades adjacent brain tissue, the corresponding focal symptoms occur. Because the tumor is located in different parts and the direction of development, its performance is also the same. The most common symptom is hypothalamic lesion, which includes endocrine and metabolic disorders, such as sexual function. Change, obesity reproductive incompetent malnutrition syndrome and water and salt metabolism disorders, which are the main symptoms often appear in the third ventricle tumor, clinical manifestations of loss of libido, impotence, irregular menstruation or menopause; Precocious puberty, due to hypothalamic and fat metabolism, can cause abnormal distribution of fat and obesity, some patients with diabetes insipidus, anorexia when the appetite center is violated, occasionally appetite hyperthyroidism, a few in the process of disease The patient develops drowsiness, the tumor develops backward, and the midbrain, tetracycline-impaired patients have difficulty in upper vision, hearing loss and oculomotor nerve paralysis. The third ventricle tumor often affects the hippocampus-thalamic-hypothalamus and the nipple. Contact, the patient may have memory loss and mental changes, when the tumor oppresses the brain stem to affect its blood supply, both lower limbs will appear The force is diminished, the patient has a soft fall of the leg. The anterior third ventricle tumor has vision loss and visual field defect due to optic nerve and optic chiasm. A small number of patients have inter-cerebral seizures, clinically manifested as nausea and vomiting, sweating. , facial flushing, pupil changes, palpitations and other autonomic symptoms.
Symptom
Third ventricle tumor symptoms Common symptoms Facial flushing nausea Hearing loss Diabetes collapse Anorexia severe headache High intracranial pressure syndrome
Due to the narrow ventricle of the third ventricle, early tumors tend to block the cerebrospinal fluid circulation pathway, resulting in increased intracranial pressure and gradually worsening. If the tumor is small and has not been blocked, the patient may have no obvious symptoms when the tumor invades the tissue surrounding the third ventricle. Then produce focal symptoms.
1. Increased intracranial pressure:
Due to the obstruction of the tumor, the cerebrospinal fluid circulation disorder causes an increase in intracranial pressure. In clinical patients, the patient presents with severe headache, nausea and vomiting. The headache is often temporarily relieved due to changes in head position and position. This may be due to the presence of a flap. The movement of the tumor in the ventricle temporarily relieves the obstruction, and the cerebrospinal fluid circulation pathway is smoothed, so that the headache is relieved or stopped, the obstruction is repeated, and the headache occurs again. In severe cases, coma or even death may occur, and the patient often exhibits compulsive head position and coercion. Sexual position, most patients have increased headaches when lying on their backs and relieved when lying down. Therefore, patients often take a downward facing posture during sleep to relieve headache attacks.
2. Focal symptoms:
When the tumor invades adjacent brain tissue, the corresponding focal symptoms occur. Because the tumor is located in different parts and the direction of development, its performance is also the same. The most common symptom is hypothalamic lesion, which includes endocrine and metabolic disorders, such as sexual function. Change, obesity reproductive incompetent malnutrition syndrome and water and salt metabolism disorders, which are the main symptoms often appear in the third ventricle tumor, clinical manifestations of loss of libido, impotence, irregular menstruation or menopause; Precocious puberty, due to hypothalamic and fat metabolism, can cause abnormal distribution of fat and obesity, some patients with diabetes insipidus, anorexia when the appetite center is violated, occasionally appetite hyperthyroidism, a few in the process of disease The patient develops drowsiness, the tumor develops backward, and the midbrain, tetracycline-impaired patients have difficulty in upper vision, hearing loss and oculomotor nerve paralysis. The third ventricle tumor often affects the hippocampus-thalamic-hypothalamus and the nipple. Contact, patients may have memory loss and mental changes, when the tumor oppresses the brain stem affects its blood supply, it will appear double Muscle strength, the patient has a soft fall of the leg, the third ventricle front tumor due to optic nerve, optic chiasm caused by vision loss and visual field defects, a small number of patients have inter-cerebral seizures, clinical manifestations of nausea and vomiting, out Khan, flushing, pupil changes, palpitations and other autonomic symptoms.
3. Fundus changes:
The fundus changes of the patient are mainly optic nerve head edema caused by increased intracranial pressure, which is characterized by unclear nipple boundary, disappearance of physiological depression, and some tumors invaded by the third brain outside the third ventricle, due to its direct optic nerve. Compression, the primary atrophy of the optic nerve, such as craniopharyngioma, pituitary adenoma, etc., long-term increased intracranial pressure will occur secondary optic atrophy, the patient's vision decreased or even blind.
4. Other:
Tumors that invade the third ventricle and invade the third ventricle have special clinical manifestations of the primary site, such as pituitary dysfunction and disorder in the craniopharyngioma and pituitary adenoma, as well as visual field of vision changes, pineal tumor In addition to the symptoms of hypothalamic damage, the patient also has a special manifestation of tetraploid damage, Parinaud syndrome, patient's pupil size or bilateral pupil dilation; reproductive organs and second characteristics Sign development, sexual precocity; abnormal bone growth.
Examine
Third ventricle tumor examination
1. Skull X-ray film: The third ventricle tumor skull showed only signs of increased intracranial pressure.
2. Lumbar puncture and cerebrospinal fluid examination: the patient's intracranial pressure is increased, and the protein content and sodium content of cerebrospinal fluid are increased.
3. EEG examination: There is no special abnormal change in general EEG examination, only the performance of increased intracranial pressure is shown. The damage of the midline structure may sometimes be paroxysmal 5~7 times/second high amplitude slow wave.
4. Ventricular angiography: It has special significance in the examination of the third ventricle tumor. The ventricle angiography shows that the symmetry of the bilateral ventricle is enlarged, sometimes the third ventricle can not be developed, and the third ventricle can be filled with filling defects and tumor tissue, third The development of the ventricle depends on whether the interventricular space is blocked.
Diagnosis
Diagnosis and diagnosis of third ventricle tumor
Differential diagnosis
Pineal tumor
Pineal tumors account for 1 to 2% of intracranial tumors, and the age of onset is 10 to 20 years old. Males are more than females. Clinically, the main manifestations are increased intracranial pressure, adjacent tissue compression symptoms and endocrine disorders. Upward and downward development invades the third ventricle or oppresses the midbrain aqueduct, so that the cerebrospinal fluid circulation is blocked and the intracranial pressure is increased. The patient has a headache in the forehead or ankle. The intracranial pressure is often progressively aggravated. When the body is involved, the patient's eyeball moves up or down in the same direction, and the pupil may be scattered or the size of the bilateral pupils may be different. Sometimes, there may be drooping of the eyelids, and some patients may have symptoms such as hearing loss and tinnitus. Brain stem and cerebellar arm are violated, patients with pyramidal tract disease and ataxia, generally late, endocrine disorders only appear in male children, early precocious puberty and abnormal skeletal development, X-ray cranial plain often seen pineal gland Increased calcification, ventriculography showed lateral and ventricular enlargement, filling defects in the third ventricle and forward movement of the midbrain aqueduct, cerebral angiography showed large and large venous elevation.
2. Craniopharyngioma
The craniopharyngioma is a residual tumor of the embryo, which occurs in the saddle and is more common in children. The main clinical manifestations are:
1 increased intracranial pressure symptoms: patients with headache, nausea and vomiting, decreased vision and double vision.
2 endocrine disorders: patients with sexual dysfunction, manifested as loss of libido, impotence, menopause, etc., in childhood, the growth of children with growth retardation, although adult but seemingly children, mental development is not affected, in addition, About 32% of patients have polydipsia and even diabetes insipidus. A few patients have abnormal distribution of fat and become obese.
3 visual field of vision changes, this is caused by tumor oppression of the optic nerve, the patient has decreased vision and visual field defects, more common in bilateral hemianopia, patients with papilledema, optic nerve can be primary atrophy, if the skull is in the flat Calcification found in the saddle or on the saddle is more conducive to the diagnosis of craniopharyngioma, and it is not difficult to identify with the third ventricle tumor.
3. Suspected color pituitary adenoma chromophobe pituitary adenoma is derived from the chromophobe cells of the pituitary gland. It is more common in adults aged 20 to 50 years old and appears clinically:
1 pituitary dysfunction: manifested as loss of libido, impotence, beard and pubic hair reduction, severe testicular atrophy, prolonged menstrual cycle in women or even menopause, while the patient's body is gradually obese, lazy and weak, basal metabolism is lower than normal A small number of patients may have more polyuria.
2 visual field of vision disorder: about 2/3 of the patients have vision loss, most patients start from one eye and then another, the visual acuity is progressively aggravated, eventually leading to blindness, almost all patients have visual field defects, mostly double Lateral hemianopia, followed by a blind side of the other side of the blindness or blindness of the other side of the eye is normal, and some patients are even blind.
3 The patient's optic nerve head was mostly atrophic, and the color of the nipple became pale. As time went on and the optic nerve pressure increased, it became silvery white, and finally turned pale, and the vision gradually weakened and became blind.
42/3 of the patients had headaches, mostly located on the bilateral or frontal, often with persistent pain, without nausea and vomiting.
The 5X line skull showed that the sella was spherical or pelvic-shaped, and the CT scan showed tumor tissue.
4. Brain stem tumor
Patients have mild intracranial hypertension, especially those with midbrain tumors. The symptoms of increased intracranial pressure appear early and more prominent. Most patients have altered consciousness and mental disorders. Because of brain stem reticular damage, patients Performance of sleepiness, apathy and hallucinations, slow progressive cross-paralysis is a prominent feature of brain stem tumors, while patients with multiple cranial nerve damage, late and spinal examination can find increased intracranial pressure, its protein content is also increased, Gas cerebral angiography showed enlargement of the lateral ventricle and the third ventricle, especially in the midbrain tumor. Sometimes the third ventricle was filled with defects. In some patients, cerebral angiography showed deformation and shift of the posterior cerebral artery, basilar artery and basilar artery. Bit.
5. Saddle nodule meningioma
Most of the patients have visual impairment and headache as the first symptom with visual field defect. Most of the visual impairment begins with one eye and then spreads to the other eye. Common sacral hemianopia or blindness in one eye and unilateral hemianopia in the other eye. The optic nerve is primary. Sexual atrophy, secondary is rare, endocrine disorders are characterized by loss of libido, impotence and amenorrhea, sometimes patients have illusory scent, oculomotor nerve palsy and half-body dysfunction, etc., the skull X-ray film generally does not change the saddle, Only a small number of patients can have a shortening of the saddle back. Cerebral angiography shows that the anterior cerebral artery root is displaced upward and backward. The diameter of the ophthalmic artery often increases and branches to the saddle nodule to supply the tumor.
6. Intraventricular hematoma
Occurred in the elderly, due to atherosclerotic craniocerebral trauma, vascular rupture, intraventricular hematoma, the patient has a history of traumatic brain injury, the patient is deeply comatose after the injury and there is a sharp increase in intracranial pressure, the patient can be very Bilateral pyramidal tract signs appear rapidly, bilateral pupils are dilated or shrunk, irregular breathing and degenerative brain, patients generally have no local signs, but meningeal irritation is obvious, sometimes symptoms of autonomic dysfunction, lumbar puncture Cerebrospinal fluid pressure increased and bloody, cerebral angiography showed enlarged ventricles, brain CT examination showed high density localized images in the ventricles.
