儿童幕下髓母细胞瘤的诊断及显微手术治疗（附28例报道）

目的 探讨儿童幕下髓母细胞瘤（MB）的诊断及显微手术方法及其效果。方法 回顾性分析2010年1月至2017年10月经术后病理证实的28例儿童幕下MB的临床资料。根据肿瘤与第四脑室和小脑的关系，运用小脑延髓裂入路10例，采用小脑延髓裂联合小脑蚓部微切开入路18例。结果 肿瘤全切除25例，次全切除3例。围手术期无死亡。术后6个月，KPS评分100分8例，90分10例，80分5例，70分3例，60分1例，50分1例。27例术后随访8~79个月，平均50个月；20例进行足量、全程放、化疗，3例术后3年内仍原位复发；7例未听进行足量、全程放、化疗，1例术后1年椎管内种植转移，2例术后1.5年发生原位复发；23例生活自理（14例复课），4例死亡（生存时间为13~39个月，平均24个月）。结论 MB恶性程度很高，术后极易复发；术后及时予放、化治疗是必不可少的辅助措施，有利于防止肿瘤复发和播散转移；术前正确的入路选择、熟练应用显微手术技巧，是取得良好疗效、降低并发症的关键。

Diagnosis and microsurgical treatment of infratentorial medulloblastomas in children ( report of 28 cases)

Objective To explore the diagnosis and microsurgical skills of infratentorial medulloblastomas in children. Methods The clinical data of 28 children with the infratentorial medulloblastomas which were pathologically proved after the surgery between January, 2010 and October, 2017 were analyzed retrospectively. Of these 28 children, 10 underwent microsurgery via the cerebellomedullary fissure approach and 18 via cerebellomedullary fissure combined with cerebellar vermis microincision approach according to the relationship of the tumors with the fourth ventricle and cerebellum. Results The tumors were totally resected in 25 children(89.2%) and subtotally in 3 (10.8%). No children perioperatively died and there were no postoperative complications related to the surgery in all the children. During a mean follow-up of 50 months (8~79 months), 23 of 27 patients, including 14 returning to school, took care of themselves and 4 of 27 patients died. Conclusion The correct choice of surgical approach before the operation and skilled microsurgical technique are the keys to good curative effect and reducing complications in the children with infratentorial medulloblastomas.