儿童第四脑室肿瘤的显微外科治疗(附43例报告)

Microsurgery for the tumors of the fourth ventricles in children (report of 43 cases)

目的探讨儿童第四脑室常见肿瘤的诊断和显微手术技巧。方法回顾性分析2006～2010年手术治疗的43例儿童第四脑室肿瘤患者的临床表现与影像学等临床资料;根据肿瘤与小脑蚓部和第四脑室的关系,设计个体化手术入路切除肿瘤。结果肿瘤全切除38例,次全切5例(为与第四脑室底粘连紧密者)。绝大多数病例无明显并发症或并发症较轻,经治疗后好转。病理结果示髓母细胞瘤27例,室管膜瘤8例,星形细胞瘤7例(其中毛细胞型3例),神经细胞瘤(交界性)1例。髓母细胞及WHOⅢ级的室管膜瘤术后进行了全脑和脊髓放疗,次全切的室管膜瘤和星形细胞瘤进行了局部放疗。结论儿童第四脑室肿瘤以髓母细胞瘤最多见,其次是室管膜瘤和星形细胞瘤;正确的入路选择和手术技巧是取得良好疗效、减少并发症的关键。

Objective To explore the diagnosis and microsurgical skill of the fourth ventricle tumors in children. Methods Clinical data of 43 children with fourth ventricle tumors who were treated by microsurgery in our department from 2006 to 2010 were analyzed retrospectively, including clinical manifestation, imaging data and so on. The individual operative approaches were designed according to the relationship of the tumors with the fourth ventricles and vermis cerebelli. The tumors in the vermis cerebelli were removed by microsurgery through the vermis cerebelli approach. The tumors in the lateral areas of the fourth ventricles or the areas near the brain stems were removed by microsurgery through the cerebellomedullary fissure approach. The tumors tightly adhered to the brain stem were not totally resected with difficulty. Results Of 43 children with fourth ventricle tumors, 38 received the total removal of the tumors and 5 subtotal. No severe postopertive complications occurred in all the patients in whom there were slight postopertive complications mending after the treatment. Pathological examination showed that 27 children had medulloblastomas, 8 ependymomas, 7 astrocytomas and 1 neurocytoma. Radiotherapy of whole brain and spinal cord was performed in the children with medulloblastomas and ependymomas of WHO grade Ⅲ and local radiotherapy in the children with ependymomas and astrocytomas undergoing the subtotal removal of the tumors. Conclusions The medulloblastoma is the most c9mmon and ependymoma and astrocytoma rank next to the medulloblastoma in the children with fourth ventricle tumors. The correct operative approach and gentle microsurgical skill are very important to good curative effect and decrease in postoperative complications.