经小脑延髓裂入路切除第四脑室及桥脑中上段占位性病变的临床研究

Resection of neoplasm in fourth ventricle and at the back of pons through cerebellomedullary fissure approach

目的 探讨经小脑延髓裂入路切除桥脑背侧及第四脑室内占位性病变手术的优点及显微手术技巧。方法 2 3例脑占位性病变均经后颅凹正中开颅 ,经小脑延髓裂入路 ,显微镜下切除桥脑和第四脑室肿瘤。结果 病变全切除 2 0例 ,次全切除 3例 ,全切率 87% ,次全切除率 13%。无一例手术死亡。结论 经小脑延髓裂入路切除第四脑室内及桥脑背侧占位性病变 ,不需切开小脑下蚓部。可清楚地暴露导水管口 ,其下方病变显示更加清楚 ,不损伤任何小脑组织 ,能最大限度地减少牵拉血管及神经组织 ,使手术更安全。术后病人不良反应极小。

Objective To investigate the advantage of cerebellomedullary fissure approach to resect the space occupying lesion in the fourth ventricle region and at the back of pons and to discuss the microsurgical skills. Methods The craniotomy is through the posterior fossa. To maximize the width of exposure, a long skin incision is made from the occipital protuberance down to the C4 5 level, and a free occipital bone flap is turned. The tonsils of cerebellum are reached by opening the tonsillovermian fissure and then moved upward so as to expose the operating field. Neoplasm in the fourth ventricle and at the back of pons was resected. Results Among the 23 cases, total resection was achieved in 20, and subtotal resection in 3. Conclusion The cerebellomedullary fissure approach can provide a panoramic view between the two lateral recesses and from the obex to the aqueduct without excision of neural tissue. During the operation, the inferior vermis is not incised. The vessels and nervous tissue are extracted at a minimum extent. Such a procedure is much safer.