显微手术治疗儿童第四脑室肿瘤

目的：对儿童第四脑室肿瘤的早期诊断、手术策略和技巧及术后并发症进行分析讨论.方法：回顾性分析中国医大盛京医院1993年1月至2008年12月儿童第四脑室肿瘤手术病例57例.所有患儿均经显微手术治疗.男33例,女24例.年龄9个月至14岁.所有患儿术前、术后均行头颅CT和（或）MRI检查.结果：本组手术全切除34例,次全切除20例,大部切除3例.症状较术前明显改善42例,无明显改善或加重5例;10例术后7d-2个月内行侧脑室-腹腔分流术.46例患者获得随访3-40个月,32例生活或学习良好,其中随访期内复发7例.对3岁以上的20例髓母细胞瘤,6例室管膜瘤切除术后行小剂量X线全脑脊髓神经轴放疗,6例星形胶质细胞瘤切除术后加化疗.结论：儿童第四脑室肿瘤以髓母细胞瘤最多见,其次为室管膜瘤和星形细胞瘤.早期正确诊断,术中恰当的手术策略选择及切除程度、术后并发症恰当处理和有选择性放疗是影响儿童第四脑室肿瘤预后的关键因素.

Microsurgical treatment of the fourth ventricular tumors in children

Objective： The clinical characteristics, pathological types, surgical modalities ＆ techniques, and postoperative complications of tumor of the fourth ventricular in children were analyzed and discussed. Methods ： Retrospective study was conducted on 57 cases of pediatric tumor of the fourth ventricular, admitted and treated in our hospital during the period of January 1993 to December 2008. All patients underwent microscopic surgical treatment,33 were males and 24 cases were females, age range was from 9 months to 14 - year - old. Cranial CT or MRI examination was conducted before and after the surgery for all patients. Results ： Total resection was performed in 34 patients, subtotal in 20 patients, partially removed in 3 patients. Forty two cases showed significant symptomatic improvement when compared with preoperative conditions,while 5 cases showed either non -improved conditions or increased severity afterward. In 7 days to 2 months,for 10 cases, postoperative ventriculoperitoneal shunt was performed. Forty six patients gained follow - up of 3 to 60 months, 32 patients enjoyed normal life and were able to learn well. During the follow -up period, there were 7 cases of recurrence. Twenty cases of medulloblastoma in children with age of 3 -year -old or above,6 cases which underwent surgical removal of intracranial ependymoma received small dosage of post- operative X- ray radiotherapy on the entire nervous system＇s nerve axon,6 cases of medulloblastoma in children of postoperative astrocytoma received chemotherapy. Conclusion： Medulloblastoma accounts for the main part of the fourth ventricular tumors in children followed by ependymomas and astrocytomas. Early correct diagnosis, techniques of microsurgery,total resection and post - operative radiotherapy play key roles on affecting the prognosis of these kinds of tumors.