经小脑延髓裂显微外科切除第四脑室肿瘤(附22例报告)  

Microsurgical management of tumors in the fourth ventricle tumors via trans-cerebellomedullary fissure approach: review of 22 cases

作　　者：仇波[1] 张东勇[1] 林毅[1] 张世刚[1] 王运杰[1] 

机构地区：[1]中国医科大学附属第一医院神经外科,辽宁沈阳110001

出　　处：《现代肿瘤医学》2013年第10期2211-2214,共4页Journal of Modern Oncology

基　　金：国家自然科学基金青年基金(编号:81001124)

摘　　要：目的:总结经小脑延髓裂入路显微手术切除第四脑室内肿瘤的手术方法,提高手术治疗效果。方法:回顾性分析2006年3月至2010年9月收治的22例第四脑室肿瘤患者的临床资料。患者均采用枕下后正中切口,打开小脑延髓裂后暴露并显微切除第四脑室肿瘤。1例患者为获得充分显露而切开下髓帆,硬脑膜予以严密缝合或修补。结果:病变全切除19例,近全切除3例。术后病理证实为室管膜瘤10例,星形细胞瘤4例,髓母细胞瘤2例,血管母细胞瘤2例,海绵状血管瘤3例,表皮样囊肿1例。无围手术期死亡,术后患者均未出现与手术入路及术中牵拉有关的并发症。1例患者术后脑积水,行脑室腹腔分流术后好转。结论:经小脑延髓裂入路能较好地暴露第四脑室肿瘤,对小脑损伤小,牵拉轻,是一种安全的手术入路。Objective：To evaluate the surgical procedure and clinical effect of trans - eerebellomedullary fissure approach to excise the fourth ventricle tumors in 22 cases. Methods： Clinical data of 22 inpatients with the fourth ven- tricle neoplasms between March 2006 and September 2010 were analyzed retrospectively. All patients received suboe- cipital median posterior fossa craniotomy and trans - cerebellomedullary fissure approach to resect the tumors micro- surgieally. One case underwent an additional incision of inferior medullary velum to obtain well exposure of the lesion. Results：Total tumor resection was achieved in 19 patients and subtotal in 3 patients. Post- operatix, e pathological di- agnosis confirmed 10 ependymomas,4 astrocytomas ,2 medulloblastomas,2 angioblastomas,3 cavernous angiomas and 1 epidermoid cyst. No death happened in this group perioperatively and none presented mutism or other complications related to surgical approach. 1 case suffered from postoperative hydrocephalus received ventriculo - peritoneal shunt and the symptoms were relieved. Conclusion：The cerebellomedullary fissure approach can provide a safe and suffi- cient exposure to resect the fourth ventricle tumors without incision of the inferior vermis. This approach prevents from damage to normal cerebellum and improves curative effects.

关 键 词：小脑延髓裂 第四脑室 肿瘤 显微外科 

分 类 号：R730.56[医药卫生—肿瘤]