颅后窝非实质型血管母细胞瘤手术疗效分析

Curative analysis of different surgical treatments for non-solid hemangioblastoma in posterior cranial fossa

目的分析不同术式治疗颅后窝非实质型血管母细胞瘤效果,以探讨合理手术方式。方法共61例颅后窝非实质型血管母细胞瘤患者,分为正中入路开放枕骨大孔和寰椎组、正中入路不开放枕骨大孔和寰椎组、旁正中入路开放枕骨大孔和寰椎组、旁正中入路不开放枕骨大孔和寰椎组、乙状窦后入路组,评价手术疗效和术后并发症发生率。结果 61例患者中手术全切除56例(91.80%)、部分切除5例(8.20%)。43例有脑积水的患者术后脑积水缓解率达79.07%(34/43)。术后并发症以颅内感染最为多见,占22.95%(14/61),开放枕骨大孔和寰椎并回纳骨瓣(6/8)、开放枕骨大孔和寰椎不回纳骨瓣(25%)、不开放枕骨大孔和寰椎并回纳骨瓣(6.90%)、不开放枕骨大孔和寰椎不回纳骨瓣(1/4)患者颅内感染发生率差异具有统计学意义(Z=16.269,P=0.001),其中以不开放枕骨大孔和寰椎并回纳骨瓣者颅内感染发生率最低(P=0.002,0.008,0.041)。结论颅后窝非实质型血管母细胞瘤应在术者经验和患者病情允许的情况下,尽量选择不开放枕骨大孔和寰椎并回纳骨瓣的方式,以减少术后并发症。

Objective The article analyzed the curative effect of different surgical treatments fornon-solid hemangioblastoma in posterior cranial fossa to explore reasonable operation method.Methods Clinical data of 61 patients with non-solid hemangioblastoma who underwent surgeries in Tianjin HuanhuHospital during July 2007 and June 2014 were retrospectively analyzed. According to surgical approachesand the situation of foramen magnum and atlas, these patients were divided into 5 groups： midline approachopening foramen magnum and atlas（Group A）, midline approach without opening foramen magnum andatlas（Group B）, paramedian approach opening foramen magnum and atlas（Group C）, paramedian approachwithout opening foramen magnum and atlas（Group D）, retrosigmoid approach（Group E）. By collectingclinical symptoms, imaging findings, surgical records and postoperative complications, the surgical resultsand occurrence of postoperative complications were summarized and reasonable operation method wasdiscussed.ResultsAmong 61 patients, total resection was achieved in 56 cases（91.80%）, and partialresection was achieved in 5 cases（8.20%）. The postoperative remission rate of 43 cases withhydrocephalus was 79.07%（34/43）. Intracranial infection was the most common postoperative complication,accounting for 22.95%（14/61）. There was significant difference in occurrence rate of intracranial infectionamong 4 subgroups： opening or not opening the foramen magnum and atlas with or without restoring boneflap（Z = 16.269, P = 0.001）. In the subgroup of not opening foramen magnum and atlas with restoring boneflap, the infection rate, which accounted for 6.90%（2/29）, was the lowest.ConclusionsThe surgicaltreatment options for non-solid hemangioblastoma in posterior fossa should be done according to patients＇ condition, and performed by a professional group. If conditions allow, not to open the foramen magnum andatlas, as well as intraoperative restoring bone flap should be chosen as far as possible, so as to reduce theoccurrence of postoperative complications..