经膜髓帆入路显微切除第四脑室肿瘤

Microsurgical resection of the fourth ventricle tumors through the telovelar approach

目的分析经膜髓帆入路切除第四脑室肿瘤的方法和临床疗效，探讨根据肿瘤特点打开膜髓帆的范围。方法回顾性分析2013年1月至2016年12月南京脑科医院神经外科收治的21例采用经膜髓帆入路切除第四脑室肿瘤患者的临床资料。其中18例采用单侧入路，3例采用双侧入路。结果21例第四脑室肿瘤患者中，肿瘤全切除17例，次全切除4例。术后病理结果：室管膜瘤12例，海绵状血管畸形3例，血管网织细胞瘤2例，髓母细胞瘤2例，表皮样囊肿2例。无手术死亡病例。随访3个月至2年，患者恢复良好，无手术相关的远期并发症。结论经膜髓帆入路无需切开小脑蚓部即可以很好地显露第四脑室，对于大多数肿瘤只需打开单侧脉络膜即可。利用脑组织本身的解剖间隙，最大程度地减少对组织的损伤，可有效避免术后并发症的发生。

Objective To analyze the resection methods of the 4th ventricle tumor resection and clinical effect through the telovelar approach and to explore the opening portion of the tela choroidea and the inferior medullary velum based on the characteristics of tumors. Methods The clinical data of 21 patients in the Neurosurgery Department of Nanjing Brain Hospital from January 2013 to December 2016 who underwent resection of the 4th ventricle tumors through telovelar approach were retrospectively analyzed. Among them, unilateral approach was employed in 18 patients and bilateral approaches in 3 cases. Results Among the 21 patients, total resection was achieved in 17 cases and subtotal resection in 4 cases. The pathological results demonstrated the ependymoma in 12 cases, cavernoma in 3 cases, bemoblastoma in 2 cases, medulloblastoma in 2 cases and cholesteatoma in 2 cases. There was no death. The patients were followed up from 3 months to 2 years. The patients recovered well and had no long-term complications related to surgery. Conclusions The exposure of the 4th ventricle seems satisfactory through the telovelar approach without splitting the vermis. In most cases, the unilateral telovelar approach with merely the tela choroidea incision is adequate. That surgical procedure using the normal anatomical fissures could minimize brain injury and effectively prevent postoperative complications.