经膜帆入路手术治疗第四脑室髓母细胞瘤

Clinical efficacy of microsurgery through telovelar approach for patients with fourth ventricle medulloblastoma

目的 探讨经膜帆入路显微手术肿瘤第四脑室髓母细胞瘤的方法及疗效。方法 回顾性分析2014年11月至2020年7月经膜帆入路显微手术治疗的17例第四脑室髓母细胞瘤的临床资料。结果 肿瘤全切除15例(88.2%),次全切除2例(11.8%)。15例颅内压增高症状术后明显缓解;1例脑积水术后未缓解,改行脑室-腹腔分流术;1例术后因呼吸衰竭死亡。术后未出现小脑性缄默及眼球震颤等并发症。出院时,GOS评分5分13例(76.5%),4分3例(17.6%),1分1例(5.9%)。结论 髓母细胞瘤的治疗以显微手术为主,经膜帆入路是到达第四脑室肿瘤的一种安全有效的术式,可减少小脑相关并发症,改善髓母细胞瘤病人的临床预后。

Objective To investigate the methods and outcomes of microsurgery through telovelar approach for the patients with fourth ventricle medulloblastoma. Methods The clinical data of 17 patients with fourth ventricle medulloblastoma who underwent microsurgery through telovelar approach from November 2014 to July 2020 were retrospectively analyzed. Results Total tumor resection was achieved in 15 patients(88.2%), and subtotal in 2(11.8%). The symptoms caused by increased intracranial pressure were significantly relieved in 15 patients after operation. Ventriculo-peritoneal shunt was performed on 1 patient due no relief of hydrocephalus after operation. One patient died of respiratory failure after operation. There were no postoperative complications such as cerebellar mutism and nystagmus. On discharge, GOS score of 5 was achieved in 13 patients(76.5%), score of 4 in 3(17.6%), and score of 1 in 1(5.9%). Conclusions Microsurgery is the main treatment of fourth ventricle medulloblastomas. The microsurgery through telovelar approach is a safe and effective method to resect the fourth ventricle tumors, which can reduce cerebellar-related complications and improve the clinical prognosis of patients with fourth ventricle medulloblastoma.