膜髓帆入路在四脑室肿瘤切除中的临床应用

The clinical application of the telovelar approach in tumor resection of the fourth ventricle

目的探讨膜髓帆入路在四脑室肿瘤切除中的安全性。方法分析我院2012年7月至2017年7月经膜髓帆入路切除四脑室肿瘤的30例患者临床资料。结果其中25例患者肿瘤全切除，5例次全切除。患者术后恢复良好[格拉斯哥治疗结果分级（GOS） 5分]24例；轻残（GOS 4分）4例，术后有面部麻木、口角歪斜症状；重残（GOS 3分）1例，术后发生一侧肢体偏瘫；死亡（GOS 1分）1例。所有幸存患者均无术后缄默改变，术后随访时间2～40个月不等，磁共振（MR）复查结果均未见明显复发。术后病理证实：室管膜瘤12例，蛛网膜囊肿2例，星形细胞瘤5例，髓母细胞瘤2例，脉络丛乳头状瘤2例，转移性癌2例，中枢神经细胞瘤2例，血管母细胞瘤2例，海绵状血管瘤1例。结论四脑室肿瘤手术难度极大，膜髓帆入路可充分暴露四脑室肿瘤，避免切开小脑蚓部，降低术后并发症发生。

ObjectiveTo investigate the safety of telovelar approach for removing the fourth ventricle tumors.MethodsThe clinical data of 30 patients with fourth ventricle tumors was analyzed from July, 2012 to July, 2017 in our hospital. All patients were treated through telovelar approach.Results25 cases had total tumor resection and 5 cases had subtotal resection. 24 cases recovered well after operation [Glasgow treatment outcome classification （GOS）： 5 points]. 4 cases suffered from facial numbness and deviated mouth （GOS： 4 points）, limb hemiparesis occurred in one case （GOS： 3 points）. One patient died from pulmonary infection （GOS： 1 points）. None of the survived patients underwent reticence, and the follow-up duration was 2 to 40 months. No obvious tumor recurrence occurred. Pathology results confirmed： 12 cases of ependymoma, 5 cases of astrocytoma, 2 cases of arachnoid cyst, 2 cases of medulloblastoma, 2 cases of choroid plexus papilloma, 2 cases of metastatic carcinoma, 2 cases of central neurocytoma, 2 cases of hemangioblastoma and 1 case of cavernous hemangioma.ConclusionResection of the fourth ventricle tumors is very difficult. The tumors can fully be exposed through telovelar approach which avoiding the incision of the vermis and reducing the complications.