髓母细胞瘤的手术入路选择

Selection of surgical approaches for medulloblastoma

脑干和小脑是进入第四脑室的主要手术障碍。小脑延髓裂(CMF)是小脑扁桃体、蚓部与延髓之间天自然的解剖裂隙,经CMF入路沿自然无血管平面的解剖,通过切除、切开脉络膜和下髓帆,使手术暴露和工作范围最大化的同时避免了小脑蚓部切开,联合C1后弓切除,改善了第四脑室上部的上下方向的暴露,提供额外的手术路径。当髓母细胞瘤已经通过第四脑室正中孔建立了肿瘤走廊的手术路径时,明显扩大术野的显露范围,并减轻了对小脑扁桃体的牵拉。本文围绕CMF入路的设计理念、开放类型、显露范围和入路的优缺点综述如下。

The brain stem and cerebellum are the main surgical barriers to the fourth ventricle.Cerebellar medullar fissure(CMF)is the natural anatomic fissure among amygdala,cerebellum vermis and medulla oblongata.The CMF operative approach via natural avascular flat anatomy,thus by excision,incision under the choroid and pith sail,to maximize exposure and scope of work at the same time avoid the cerebellar vermis incision,joint C1 arch after resection,could improved the upper part of the fourth ventricle and direction of exposure,and provide additional surgery path.When medulloblastoma had established a surgical path through the tumor corridor through the median foramen of the fourth ventricle,the exposure of the surgical field was significantly expanded and the traction of the cerebellar tonsils was reduced.In this paper,the design concept,open type,exposure range and advantages and disadvantages of CMF approach are summarized as follows.