经小脑延髓裂入路显微手术治疗儿童第四脑室肿瘤

Microsurgery of fourth ventricle tumor in children via transcerebeliomedullary fissure approach

目的探讨经小脑延髓裂（CMF）人路显微手术治疗儿童第四脑室肿瘤的方法，提高手术治疗效果。方法对17例2～14岁原发第四脑室肿瘤患儿，采用枕下正中切口、横窦下颅骨开窗骨瓣成形及经4,N延髓裂入路显微切除肿瘤，其中广泛型CMF切开12例，外侧壁型切开3例，外侧隐窝切开2例；硬脑膜严密缝合或修补，骨瓣复位并固定。结果肿瘤全切除15例，次全切除2例，病理结果髓母细胞瘤9例，室管膜瘤5例，星形细胞瘤3例，无同手术期死亡发生。术后15例患儿症状体征均明显改善或消失，无新发共济失调、震颤、肌张力降低及脑积水、小脑缄默综合征等并发症。复发2例，均为髓母细胞瘤，2年后死亡I例。结论经小脑延髓裂人路能较好地显露儿童第四脑室肿瘤，可减少因切开小脑蚓部和向侧方牵拉损伤小脑所导致的并发症发生。

Objective To investigate the clinical effects and surgical techniques of the transcere bellomedullary fissure （trans-CMF）approach to resect the fourth ventricle tumors in children. Methods Seventeen children with the fourth ventricle neoplasm underwent resection via suboccipital median posterior fossa cranioplasty and trans CMF approach, hereinto extensive （aqueduct） opening in 2, lateral wall opening in 3 and lateral recess opening in 2 cases. Results Total tumor resection was achieved in 15,and subtotal resection in 2. No death happened in this group. There were no new neurological deficits. Symptoms such as headache, vomiting, ataxia and vision were improved or disappeared after operation. None of them presented tourism. Conclusions The trans-CMFb approach can provide a sufficient exposure to resect the fourth ventricle neoplasm in children without incision of cerebellar inferior vermis or injury to cerebellar tissues.