儿童髓母细胞瘤显微手术治疗及术后并发症探讨

目的探讨儿童髓母细胞瘤显微手术及术后并发症问题。方法回顾性分析经小脑蚓部切开联合四脑室正中孔入路显微手术切除儿童髓母细胞瘤及术后并发症53例。全部经病理证实。结果全部病例术前均行MRI检查,46例同时行CT检查。手术全切除47例(88.7%)、次全切除6例(11.3%)。术后51例高颅压症状消失,临床体征改善,2例死亡。术后发生咸默症5例,其中合并下颏关节脱位1例。术后昏迷2例,呼吸机辅助人工呼吸2周1例,遗留一侧肢体轻瘫2例。中枢性面瘫2例。肿瘤位于小脑蚓部12例,四脑室内18例。小脑蚓部和四脑室内者23例。肿瘤血供来源于小脑后下动脉37例。全部病例均打通中脑导水管。术后37例患者随访6个月至5年3个月。35例接受放疗。其中30例未见复发和转移。4例原位复发,2例脊髓播种性转移。结论儿童髓母细胞瘤由于其临床特点诊断多无困难,但个性化深入了解肿瘤病理解剖及其与周围组织比邻有利于最大限度切除肿瘤。采用显微手术全切除肿瘤组织、解除导水管梗阻、妥善保护小脑后下动脉及其分支、避免伤及脑干及四脑室底是手术操作的关键。病程进展迅速,肿瘤巨大者术后生存质量及生存期更差,早期就诊尤为重要。

The microsurgery technique and prevention of postoperative complication for medulloblastoma in children

Objective To discuss the microsurgery technique and prevention of postoperative complication for medulloblastoma.Methods Retrospective analysis on the postoperative complication of 53 cases of microsurgery of medulloblastoma with post fossa approach was carried.All the cases were proved by pathological methods.Results Preoperation MRI scans were performed in all cased.Among the cases,total removal 47,cases;subtotal 6,cases.Hypertension of intracranial diminished after operation.2 died.Mutism complication happened in 5 cases.2 cases suffered from coma.Hemiplegia happened in 2 cases.Central facial palsy happened in 2 cases.The location of the tumor:12 in the vermis,forth ventricle,18,both the vermis and forth ventricle,23.The blood supply origining from the cerebella posterior inferior artery was found in 37 cases. All the midbrain aqueduct were got through.37 cases were followed up from 6 months to 5 years.35 patients underwent radiotherapy.No recurrence and metastasis in 30 cases,4 cases were recurrence in the primary place.2 cases showed metastasis in the spinal cord.Conclusion It is easy to diagnosis on the clinical characteristics of childen medulloblastoma.Being familiar with anatomy can help to utmost ablate the tumor.The keys are getting through the midbrain aqueduct,protecting the cerebella posterior inferior artery and branches,avoiding to damage the brain stem and the bottom of forth ventricle.The course of this disease develops very soon.The childen with huge of the tumor have the shorter of living stage.Forepart diagnosis is very important.