儿童后颅窝肿瘤手术入路及骨瓣复位

Operative approaches and craniotomy for posterior fossa tumors in children

目的：根据后颅窝肿瘤不同部位选择最佳手术入路。后颅窝开颅术改咬骨窗为开骨瓣。方法：蚓部肿瘤选择后颅窝正中入路。小脑半球肿瘤行正中钩形切口，肿瘤偏外选择外侧钩形切口。上蚓部肿瘤选择Ｐｏｐｐｅｎ入路。三种骨瓣：正中骨瓣、单侧骨瓣、单侧跨中线骨瓣。术毕骨瓣复位。结果：实施３８例儿童后颅窝肿瘤全切除术，髓母细胞瘤２３例，星形细胞瘤１０例，室管膜瘤３例，血管母细胞瘤１例，脑脓肿１例。无皮下积液发生，３例术后１０天内发烧。结论：后颅窝开骨瓣术、硬膜缝合、骨瓣复位符合解剖复位原则，术后并发症少。

Objective: By using of suboccipital craniotomy for removal of the posterior fossa tumors in order to maintain anatomical replacement. Operative approaches were chose according to the locations of the tumors. Methods: Four approaches can be chose for the posterior were selected. Suboccipital medial approach, suboccipital middle hooked approach, suboccipital lateral hooked approach, and occipital transtentorial approach. There were three kinds of bone flaps: median, unilateral, and unilateral median. The median bone flap was used for the vermis medulloblastomas, the unilateral flap for the cerebellar tumors and the unilateral median flap for the cerebellar tumors that extended beyond the vermis. At the procedure, the upper border and the lateral border of the bone flap were cut by Gigli saw or cranitome, the lower line was opened to the foramen magnum by rongeur. Results: There were 38 patients with medulloblastomas in 23, astrocytomas in 10, ependymomas in 3, hemangioblastoma in 1, and brain abscess in 1. All cases underwent the craniotomy and the tumors were removed totally under the microscope. There were no postoperative complications. Conclusions: The advantages of suboccipital craniotmy are anatomical replacement, less postoperative complications caused by suboccipital craniectomy, and beneficial to children's mental health.