神经内镜辅助下经幕下切除后颅窝肿瘤的疗效分析(附14例报告)  

Neuroendoscopic resection of posterior cranial fossa tumors via infratentorial keyhole approach (report of 14 cases)

作　　者：曾宇 刘军[1] 王健伟 谭赢 张继勤 刘昉[1] 王俊[1] 王超[1] ZENG Yu;LIU Jun;WANG Jian-wei;WANG Chao(Department of Neurosurgery,Guizhou people s Hospital,550000 Guiyang,China)

机构地区：[1]贵州省人民医院神经外科,贵阳550000 [2]贵州省人民医院麻醉科,贵阳550000 [3]贵阳市第二人民医院神经外科三病区

出　　处：《临床神经外科杂志》2023年第1期10-14,共5页Journal of Clinical Neurosurgery

基　　金：贵州省人民医院国家自然科学基金补助基金(GPPH-NSFC-2019-9,GPPH-NSFC-2019-18,GPPH-NSFC-D-2019-17);贵州省省级科技计划项目(黔科合基础[2020]1Z066);贵州省人民医院博士基金(GZSYBS[2018]03,GZSYBS [2018]06)。

摘　　要：目的 探讨神经内镜辅助下经小脑幕下在后颅窝肿瘤的应用价值及手术经验。方法 回顾性分析2018年1月—2021年6月贵州省人民医院神经外科采用德国STORZ神经内镜经幕下治疗14例后颅窝肿瘤患者的临床资料,并结合相关文献进行复习。结果 1例合并扁平颅底,1例后纵韧带骨化屈颈困难。术中采用了乙状窦后、旁正中入路、正中入路、经幕下小脑近蚓部皮质造瘘第四脑室入路、幕下小脑上入路。术中满足显露要求,14例患者中,13例为全切除,1例为次全切除。围手术期死亡2例。术后随访两年。结论 神经内镜经幕下锁孔入路可以有效、安全地应用于后颅窝肿瘤患者,可作为切除后颅窝肿瘤的有效方式。个体化的选择神经内镜锁孔入路可以有效地帮助切除后颅窝肿瘤,尤其是儿童或合并后颅窝畸形患者。神经内镜幕下锁孔入路可以减少患者的手术创伤以及术后不适感。Objective To explore the application value and surgical experience of neuroendoscopic resection of posterior cranial fossa tumors via infratentorial keyhole approach. Methods The clinical data of 14 patients with posterior cranial fossa tumors treated by German STORZ neuroendoscopic system via infratentorial keyhole approach in the Department of Neurosurgery, Guizhou Provincial People’s Hospital from January 2018 to June 2021 were analyzed retrospectively. The relevant literature were reviewed. Results There were 1 case with flat skull base, 1 case with posterior longitudinal ligament ossification. The retrosigmoid approach, the paramedian approach, the median approach, the fourth ventriculostomy via the subcotentorial cerebellar cortex near the vermis approach, and the supratentorial cerebellar approach were used during the operation, the exposure requirements were met. Of the 14 patients, 13 were totally removed and 1 was subtotal removed. 2 died during perioperative period. The patients were followed up for 2 years. Conclusions Neuroendoscopic infratentorial keyhole approach can be effectively and safely used in patients with posterior fossa tumors and can be used as an effective way to remove posterior fossa lesions. Individualized selection of neuroendoscopic keyhole approach can effectively help to remove posterior fossa tumors, especially in children or patients with posterior fossa deformities. Neuroendoscopic infratentorial keyhole approach can reduce surgical trauma and postoperative discomfort.

关 键 词：神经内镜 锁孔入路 后颅窝 小脑幕下 

分 类 号：R651[医药卫生—外科学]