内镜辅助下经外侧壁型小脑延髓裂入路切除第四脑室占位性病变

Resection of the fourth ventricle tumors through lateral wall type of the cerebeiiomedullary fissure approach under endoscope

目的探讨神经内镜辅助下经外侧壁型小脑延髓裂入路对第四脑室肿瘤的治疗效果。方法回顾性分析14例第四脑室占位性病变患者的临床资料。所有患者均经外侧壁型小脑延髓裂入路进行手术治疗，对于向导水管深部发展的肿瘤暴露效果欠佳者，采用内镜辅助操作，术中辅以神经电生理监测及术中B超。结果病变全切除12例，近全切除1例，大部分切除1例。术后病理诊断：髓母细胞瘤4例，表皮样囊肿3例，室管膜瘤2例，血管母细胞瘤2例，脑膜瘤1例，海绵状血管瘤1例，星形细胞瘤1例。所有患者均恢复正常脑脊液循环通路，术前症状均无明显加重，无面瘫等神经核团损伤相关并发症发生，1例患者术后呼吸微弱给予呼吸机辅助后恢复正常。术后随访3-28个月。1例死亡．1例髓母细胞瘤复发。结论内镜辅助下经外侧壁型小脑延髓裂入路结合电生理监测及超声成像技术，能降低面瘫、听力减退等术后并发症的发生。

Objective To investigate the therapeutic effect of the fourth ventricle tumors through lat- eral wall type of the transcerebellomedullary fissure approach under endoscope. Methods Clinical data of 14 cases with the fourth ventricle lesions were analyzed retrospectively. All the patients were treated by lateral wall type of the transcerebellomedullary fissure approach surgery. The endoscope was used if the lesions de- velop to the aqueduct and hard to be exposed. Both neurophysiological monitoring and intraoperative ultra- sound were used regularly. Results Tumors were totally removed in 12 cases, subtotally in 1, and partially in 1. All the patients were diagnosed in postoperative histopathology, including.4 medulloblastoma, three epi- dermoid cyst, two ependymoma, two hemangioblastoma, one meningioma, one cavernous hemangioma and 1 astrocytoma. Hypopnea occurred immediate after operation in 1 patient. Ventilatory support was performed by Ventilator, and the respiration was restored 1 day later. Normal cerebrospinal fluid circulation was retlarn in all cases. Neither aggravation of preoperative symptoms nor nuclei injury related complication had been found. The follow-up interval between 3 months to 28 months, one patient was dead with unexplained, and 1 medulloblas- toma patient was relapse. Conclusion Lateral wall type of the transcerebellomedullary fissure approach un- der endoscope, combined with the usage of ueurophysiological monitoring and intraoperative ultrasound, can de- grade the surgical related complications such as facial palsy and amblyacousia.