1 rare case of lateral ventricular wall biliary lioma

The male, 21, was admitted to hospital on 31 May 2018 due to a physical impairment on his left side for 15 yearsAt the age of 6, the patient found a right side ventricular wall occupatic lesions, about 2.0 cm x 2.1 cm x 1.6 cm in sizeAt that time, there was a left limb dysfunction, the left upper and lower limb muscle strength IV level, the limb muscletensionnormal, and in the hospital head gamma knife treatmentAt the age of 7, there was no change in the right side ventricular wall occupal lesions20 years old cranial brain MRI examination found that intracranial lesions increased, about 3.0 cm x 2.9 cm x 2.6 cm, the left limb muscle strength further reduced to level III, to the hospital again gamma knife treatmentBefore this admission, the left limb muscle strength further decreased, the vision of the eyes decreased, the left eye side of the vision is blindadmission to the hospital physical examination: clear mind, forehead lines exist, the eyes can be completely closed, no significant offset in the spatEyevision 4.8 in both eyes and blind vision on the left side of the eyeThe left upper limb muscle strength class II, the left hand 1 to 5 finger flexion malformation, the left lower limb muscle force III level, the right limb muscle strength and muscle tone are normal, the left limb physiological reflex is weakened, Babinski positivePreoperative precranial brain MRI sweep and enhancement examination: the right side ventricular wall huge occupancy lesions, growth to the brain chamber, see the mix slightly longer, such as T1 slightly longer, slightly shorter T2 signal shadow, the boundary is still clear, the above lesions are irregular edge reinforcement, the size is about 3.5 cm x 4.9 cm x 4.6 cm, the morphological rules, local and right ventricle front corner connectivity, pillow large pool expansionpreoperative: right side ventricular wall tumorA craniofacial tumor removal on June 4 at the right side ventricular wall of the whole hemp downsideSelect the right frontal lobe into the road, through the right ventricle front corner puncture success, along the puncture path into the ventricle See in surgery: the bottom of the tumor base is located in the right side ventricular wall, tumor size of about 5.0 cm x 5.0 cm x 4.0 cm, tofu slag-like change, for the reality, crisp texture, the boundary is clear, no clear blood supply artery, surrounding brain tissue and lesions have adhesion In surgery, the tumor is cut completely, with 100 mg hydrogenated pine added to 1000 ml of physiological saline repeatedly rinse the tumor cavity Postoperative diagnosis: right side ventricular wall biliary lioma June 5: inflammatory degenerative necrosis tissue and horns, some brain tissue visible cholesterol crystallization, granule semama formation, pathological diagnosis of biliary lioma After surgery, the patient recovered well, the vision of the lower eye 4.8, the left eye side vision is blind, the left upper limb muscle strength III level, the left hand 1 to 5 finger flexo malformation improved, the left lower limb muscle strength IV level, the right limb muscle strength and muscle tension are normal, cured and discharged from the hospital discussion bile lioma belongs to benign tumor, clinical manifestations produce different positioning signs and performance due to different growth sites, are insensitive to radiotherapy, surgical excision is the preferred method of treatment This case children period is found intracranial lesions, 15 years after surgical excision, preoperative consideration for diagnosis of the right side ventricular wall tube membrane tumor, during and after surgery explicitly diagnosed as the right side ventricular wall biliary lipid tumor Preoperative discussion that the patient has been ontheillating for 15 years, a long history, can be ruled out tumor as a high degree of malignant lesions Combined with the MRI examination to consider tumor cystic change, consider the tumor as: (1) ventricular membrane tumor The differentiated ventricle cells from the epithelial chamber and the central tube of the spinal cord are WHOII-level tumors, which are the third intracranial tumor sacintic after myelin and astral cytomasis, and are found in the fourth ventricle, lateral ventricle and third ventricle (2) Low-grade glioma The operation saw all the surgeons accidentally, look back at the patient's MRI images, found that the edge of the tumor has partially reinforced nodules, the center of the tumor is not a typical cystic variable characteristics, unlike the typical glioma cystic image characteristics combined with patients for 15 years, mostly benign tumors, so the rare lateral ventricular wall bilioma should be considered before surgery The tumor is insensitive to radiotherapy, so two gamma knife treatments in patients are ineffective Bile lioma is more found in the front upper part of the cerebellum bridge and saddle area, there is the characteristics of "see seam on drill" Brain chamber biliary lioma is rare, accounting for 1.2 to 2.6% of intracranial tumors, there is a complete tumor envelope, containing psoriasis-like epithelial tissue, also known as epithelial-like cysts, epidermis-like cysts, pearl tumors The disease is divided into congenital and acquired two kinds, acquired nature is mostly related to trauma Bile lioma CT is characterized by clear cyst boundaries and irregular patterns Typical is a low-density stove or a slightly low-density stove, and the enhancement is generally non-reinforced During the operation, the tumor cavity wasrepeated repeatedly with hydrogenated pine and physiological saline, which can reduce the occurrence of sterile meningitis Tumor residue is a key factor in tumor recurrence, therefore, the operation should strive for full-cut tumor In patients with partial removal of the tumor, the symptoms can be alleviated over a longer period of time, and if the tumor grows older, it can be operated on again