儿童幕下毛细胞星形细胞瘤的显微手术治疗

Microsurgical treatment for subtentorial pilocystic astrocytomas in childhood

目的探讨儿童幕下毛细胞星形细胞瘤(PA)显微手术治疗效果及手术要点。方法回顾性分析2018年3月~2019年11月显微手术治疗8例儿童幕下PA的临床资料。3例未合并梗阻性脑积水,直接行显微手术切除肿瘤;5例并发梗阻性脑积水,先行Ommaya储液囊外引流术,3~5 d后行肿瘤切除术。结果8例肿瘤均全切除,术后病理检查为PA。术后症状明显好转,未发生并发症状。5例合并梗阻性脑积水Ommaya储液囊外引流术后随访半年脑室系统逐步缩小,避免了脑室-腹腔分流术。结论儿童幕下PA的手术效果良好;对于合并梗阻性脑积水病人先行Ommaya储液囊外引流是非常必要的,操作简单,可提高肿瘤切除的安全性,避免脑室-腹腔分流术。

Objective To expore the effect of microsurgery on the subtentorial pilocystic astrocytomas in childhood and the operation essentials.Methods The clinical data of 8 children with subtentorial pilocystic astrocytoma who underwent microsurgery from March 2018 to November 2019 were analyzed retropsectively.Of 8 children,3 children without obstructive hydrocephalus received microsurgery,and the other 5 patients with obstructive hydrocephalus received Ommaya external drainage first and then received microsurgery 3~5 days later.Results Total tumor removal was achieved and the pathological results showed locystic astrocytoma in all the patients.Symptoms were relieved obviously and no complications occurred after the operation.Of the 5 patients with obstructive hydrocephalus,the ventricular system deflated obviously during the follow-up and no patients needed the ventriculoperitoneal shunt.Conclusions Microsurgery is a good treatment method for the subtentorial pilocystic astrocytomas in children.Resection of the tumor as much as possible is needed.For children with obstructive hydrocephalus,preoperative Ommaya external drainage is necessary,because it is simple,and can improve the safety of tumor resection and avoid ventricular-abdominal shunt.