经后正中小脑延髓裂入路切除儿童第四脑室肿瘤

Surgical Resection Through Posterior-medial Cerebellobulbaris Fissure Approach for the Treatment of 4th Ventricle Tumor in Children

【目的】了解经后正中小脑延髓裂入路手术切除儿童四脑室肿瘤的临床疗效及并发症。【方法】采用枕下后正中切口小脑延髓裂入路显微切除儿童第四脑室肿瘤12例。【结果】手术肿瘤全切除10例，近全切除2例。病理检查髓母细胞瘤10例，室管膜瘤2例，未能全切原因是1例因周围已种植转移未能全切，1例因与四脑室底粘连严重。术后核性面瘫（House-Black分级2级）及外展神经麻痹1例，颅内感染1例及伤口皮下积液1例。无小脑性缄默综合征及共济失调等并发症，无死亡。平均随访15个月，肿瘤复发死亡1例。【结论】经后正中小脑延髓裂入路，在不切开小脑蚓部的情况下能充分显露第四脑室，安全有效地切除第四脑室肿瘤，减少了手术并发症。

[Objective]To understand the clinical effect and complications of surgical resection through posterior-medial cerebellobulbaris fissure approach for the treatment of 4th ventricle tumor in children. [Methods]Twelve children with 4th ventricle tumor were operated by microdissection via posterior-medial cerebellob- ulbaris fissure approach. [Results] Total removal was achieved in 10 patients and subtotal removal was achieved in 2 patients. The pathological examination showed that 10 cases were medulloblastoma and 2 cases were ependymoma. The reasons that could not be totally removed were implantation metastasis around brain tissue in 1 patient and serious adhesion between tumor and medulla oblongata in another patient. Postoperative complications were nuclear facial palsy and abducens nerve palsy in 1 case, intraeranial infection in 1 ease and subcutaneous dropsy in 1 case. No case had cerebellar mutism and ataxia, There was no death. All patents were followed up for 15 months at average. One case died of relapse. [Conclusion] The posterior-medial cerebellobulbaris fissure approach can provide a sufficient exposure of 4th ventricle tumors without the incision of inferior vermis in order to effectively remove the 4th ventricle tumor with less surgical complications.