第四脑室肿瘤显微手术入路选择

目的探讨第四脑室肿瘤的显微手术入路选择。方法对我院自1999年12月至2005年12月接受手术治疗的25例第四脑室肿瘤患者的临床资料进行回顾性分析,总结手术入路选择经验。结果所有患者肿瘤全切除20例,近全切除5例,均打通导水管下口。其中经小脑蚓部入路15例,经小脑延髓裂入路10例,术后全部清醒。术后出现脑积水6例,1例死于呼吸中枢损伤。结论选择小脑蚓部入路有利于切除中孔区肿瘤,小脑延髓裂入路有利于切除靠近外侧孔区及脑干背外侧肿瘤,正确选择手术入路有助于提高手术成功率,减少并发症。

The approaches of operation on fourth ventricle tumors

Objective To investigate the microsurgical treatment of the fourth ventricle tumors. Methods The clinical data of 25 patients with the fourth ventricle tumors operated in our department from December 1999 to December 2005 were analyzed retrospectively. Results The cerebral aqueduct obstruction were solved in all patients. 20 cases underwent the total resection and 5 cases take the subtotal resection. 15 of them were used vermis incision approach and the other 10 were cerebellomedullary fissure approach. All patients were conscious after surgery. 6 patients suffered from the postoperative hydrocephalus. One patient died of the medulla oblongata injury. Conclusion Tumors near foramen of Magendie of the fourth ventricle are easy to remove with vermis incision approach. Cerebellomedullary fissure approach can be used to remove tumors near foramen of Luschka or back of brain stem. The suitable approach is helpful for improving the treatment and decreacing the complications.