小儿后颅窝中线肿瘤的显微手术治疗

Microsurgery for posterior fossa midline tumors in children

目的探讨小儿后颅窝中线肿瘤的临床特点和显微手术疗效。方法回顾性分析2011年2月至2015年2月显微手术治疗的52例小儿后颅窝中线肿瘤的临床资料。结果肿瘤全切除45例,次全切除5例,大部分切除2例。髓母细胞瘤36例(69.2%),室管膜瘤及间变性室管膜瘤7例(13.5%),星形细胞瘤7例(13.5%),少突胶质细胞瘤1例(1.9%),血管母细胞瘤1例(1.9%)。围手术期并发症发生率为44.2%(23/52)。术后无并发症短期内恢复良好29例,出现并发症延迟恢复19例,昏迷自动出院或死亡4例。康复的48例出院后随访3~48个月,平均15个月;7例肿瘤复发。结论显微手术是治疗小儿后颅窝中线肿瘤最有效的方法,术中利用小脑延髓裂间隙显露切除肿瘤能有效减少脑组织损伤,加强围手术期并发症的处理可提高疗效。

Objective To explore the clinical features of posterior fossa midline tumors and microsurgical effects on them in children. Methods The clinical data of 52 children with posterior fossa midline tumors undergoing microsurgery in Tongji Hospital from February, 2011 to February, 2015 were analyzed retrospectively. Results Of 52 children with posterior fossa midline tumors, 45 received total resection of the tumors, 5 subtotal and 2 partial. The conditions were deteriorated in 4 children after the operation. Forty-eight children followed up from 3 to 48 months were recovered well after the operation. Conclusions Microsurgery is the best effective method to treat posterior fossa midline tumors in the children. Exposure and resection of the tumors by microsurgery through the cerebellomedullary fissure approach may reduce the operation-side injury to the cerebral tissues. The potent treatment of the perioperative complications is helpful to improvement of the prognoses in the children with posterior fossa midline tumors.