髓母细胞瘤的临床特征与手术入路选择  

Clinical features and surgical approaches of medulloblastoma

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作  者:陈立华 孙恺 陈文锦 夏勇[1] 张洪钿 徐如祥 Chen Lihua;Sun Kai;Chen Wenjin;Xia Yong;Zhang Hongtian;Xu Ruxiang(Department of Neurosurgery,Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital,Chengdu 610072,China)

机构地区:[1]四川省医学科学院·四川省人民医院神经外科,成都610072

出  处:《中华脑科疾病与康复杂志(电子版)》2021年第1期41-47,共7页Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition)

摘  要:目的探讨儿童髓母细胞瘤(MDB)的临床特征和手术入路的选择。方法回顾性分析自2011年1月至2019年12月采用经小脑延髓裂(CMF)入路治疗的32例MDB患儿的临床资料,其中经单侧CMF入路28例,采用双侧CMF入路4例。分析患儿的临床特征及预后。结果发生于<10岁的儿童28例(87.5%),其中<3岁的婴幼儿占21.9%,男性占65.6%。32例患儿全部病程未超过6个月,其中3个月内者占71.9%,主要症状是颅内高压和共济运动障碍。MDB多数位于蚓部或中线部者(90.6%),位于小脑半球者只有9.4%;9.4%的MDB侵袭脑干。肿瘤全切除者29例,全切除率为90.6%;次全切除者3例,1例术后并发小脑性缄默症,1个月后完全恢复。无手术相关死亡病例,无永久性脑脊液漏。结论CMF入路是MDB的最佳手术入路,符合微创原则。掌握MDB的临床特征和CMF入路的原则及技巧,采用精湛的微创神经外科手术技术,有利于提高MDB的疗效。Objective To investigate the clinical characteristics and the selection of surgical approach for medulloblastoma(MDB)in children.Methods Retrospective analysis of clinical data of 32 children with MDB who were treated by cerebellar medullar fissure(CMF)approach(including 28 cases of unilateral cerebellar medullar fissure approach and 4 cases of bilateral CMF approach)from January 2011 to December 2019 in Neurosurgery Department of Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital.The clinical features and prognosis of the patients were analyzed.Results Among 32 cases,28 patients(87.5%)were<10 years old,21.9% were <3 years old and 65.6% were male.The longest duration of the disease in all patients was 6 months,and 71.9% cases were within 3 months,the main symptoms were intracranial hypertension and ataxia.Most of the MDBs were located in vermis or midline(90.6%),only 9.4% in cerebellum hemisphere,and 9.4% of MDB oppressed brain stem.The total resection rate was 90.6% in 29 patients,3 patients were subtotal resection,1 patient was complicated with cerebellar mutism,full recovery was achieved after 1 month.There were no surgical related deaths and no permanent cerebrospinal fluid leakage.Conclusion CMF approach is the optimal surgical approach for MDB,which is in line with minimally invasive surgery principles.Mastering the clinical features of MDB and the principles and skills of CMF approach,combined with the exquisite minimally invasive neurosurgery techniques,contributes to improving the curative effect of MDB.

关 键 词:髓母细胞瘤 小脑延髓裂入路 儿童 

分 类 号:R739.4[医药卫生—肿瘤]

 

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