经小脑延髓裂入路显微手术切除儿童第四脑室肿瘤

Microsurgery of pediatric the fourth ventricle tumor through cerebellomedullary fissure approach

目的 报道经小脑延髓裂入路显微外科手术切除儿童第四脑室肿瘤的临床疗效。 方法 采用枕下正中切口、小脑延髓裂入路在手术显微镜下切除第四脑室肿瘤 18例。 结果 手术治疗 18例 ,其中肿瘤全切除 13例 ,近全切除 5例。术后无 1例出现小脑性缄默综合征。出现脑积水 3例 ,2例经行侧脑室 腹腔分流后好转 ,1例因急性梗阻性脑积水死亡。 结论 经小脑延髓裂入路 ,不需切开小脑蚓部 ,可避免损伤正常小脑组织 ,应用显微外科技术有助切除第四脑室肿瘤 ,提高手术疗效。

Objective To evaluate the clinical effect of cerebellomedullary fissure approach to resect the fourth ventricle tumors. Methods Eightten cases of the fourth ventricle tumors that have been operated on through the posterior fossa craniotomy and cerebellomedullary fissure approach were analyzed retrospectively. Results Total turmor resection was achieved in 13 patients and subtotal in 5 patients. All patients were conscious after surgery. None of them presented mutism. Three cases suffered from postoperative hydrocephalus, ventriculoperi-toneal hunts were applied in 2 cases, another case died of acute obstructive hydrocephalus. Conclusion The cerebellomedullary fissure approach can provide a sufficent exposure to resect the fourth ventricle tumor without incision of the inferior vermis.