神经内镜辅助显微手术治疗儿童第四脑室肿瘤

Endoscope-assisted microsurgery for tumors in the fourth ventricular in children

目的探讨神经内镜辅助显微手术治疗儿童第四脑室肿瘤的临床效果。方法回顾性分析2008年1月至2013年12月神经内镜辅助小脑延髓裂入路（内镜组,32例）和小脑延髓裂联合小脑蚓部入路（对照组,31例）显微手术治疗的63例儿童第四脑室肿瘤患者的临床资料。结果内镜组全切除27例（84.4%）,次全切除5例;对照组全切除26例（83.9%）,次全切除5例。两组肿瘤全切除率无显著差异（P〉0.05）。内镜组术后小脑缄默症发生率（0%）明显低于对照组（12.9%,4/31,P〈0.05）。两组患者术后新发小脑缄默症发生率差异显著（P〈0.05）。59例术后随访6~72个月,55例正常学习、生活;4例复发（3例再次手术,恢复良好;1例死亡）。结论神经内镜辅助显微手术切除儿童第四脑室肿瘤能够避免小脑蚓部切开,减少术后并发症发生率,特别是小脑缄默症的发生率。

Objective To explore the curative effect of endoscope-assisted microsurgery on the tumors in the fourth ventricle in children. Methods The clinical data of 63 children with the fourth ventricles tumors, of whom, 32 underwent endoscope-assisted microsurgery through inferior cerebellomedullary fissure approach （observed group） and 31 underwent microsurgery through inferior vermis and cerebellomedullar fissure （control group） from January, 2008 to December, 2013, were analyzed retrospectively. The rate of total resection of the tumors and the rate of occurrence of postoperative complications were compared between both groups. Results Of 32 children in the observed group, 27 （84.4%, 27/32） received total resection of the tumors and 5 subtotal. Of 31 children in the control group, 26 （83.9%, 26/31） received total resection of the tumors and 5 subtotal. The rate of new neural injury and aggravated primary neural injury after the operation in the observed and control groups were 15.6% （5/32） and 19.4 （6/31） respectively. The rate of the usual postoperative complications including fever, infection, occipital pseudo sac hydrocephalus and so on were 16.9% （15/32） and 51.6% （16/ 31） respectively in the observed and control groups. There were insignificant differences in the rates of total resection of the tumors, new neural injury and aggravated primary neural injury and the occurrence of usual complications between both the groups （P〉0.05）. The rate of the occurrence of cerebellar mutism （12.5%, 4/32） was significantly higher in the control group than that （0.0%） in the observed group （P〈0.05）. Conclusion The endoscope-assisted microsurgery through inferior cerebellomedullary fissure approach can prevent the damage to the cerebral inferior vermis and therefore it can reduce the rate of the occurrence of the cerebellar mutism in the children with the fourth ventricles tumors.