经膜髓帆入路四脑室病变切除术的临床研究

目的探讨经膜髓帆入路切除第四脑室病变的手术方法及优点。方法17例第四脑室及周围占位病变，男7例，女10例，年龄5～49岁，平均26．6岁。其中髓母细胞瘤5例，室管膜瘤5例，表皮样囊肿2例，脑囊虫病2例，脉络丛乳头状瘤3例。手术采用小脑延髓裂膜髓帆入路，显微镜下分离两侧小脑延髓裂，游离小脑扁桃体，根据病变大小切开脉络膜和下髓帆，显露四脑室，将病变切除，严密缝合硬膜，骨瓣复位。结果17例病变均全切除，术后早期恢复良好，无重残及死亡。11例术后随访3～21个月，无重残及死亡，其中8例行CT或MRI检查，无复发。结论经小脑延髓裂膜髓帆入路切除四脑室肿瘤不需切开小脑蚓部，且可扩大四脑室的显露，减少术后并发症的发生。

Resection of neoplasm in fourth ventricle through transtelovelar approach: a clinical study

Objective To study the advantages and procedure of telovelar approach for resection of the lesion in the fourth ventricle. Methods Telovelar approach to the fourth ventricle was executed in 17 cases. Among these patients, seven were females and 10 were males. The age ranged from 5 years to 49 years with mean age of 26.6 years. Pathologically, there were 5 medulloblastomas, 5 ependymomas, 2 epidermoids, 2 brain cysticercosis, and 3 cboroid plexus papillomas. During the operation, the medullotonsillar space of the cerebellomedullary fissure and the urulotonsillar space were sharply dissected to release the tonsils from uvula and medullar oblongata bilaterally. According to the size of the neoplasm, the tela or both tela and velum were incised. The fourth ventricle was exposed adequately and the lesion was removed. All operations were performed with the help of microscope. The dura was sutured securely. Results The space occupying lesions were removed totally in all cases and all patients recovered very well, and threre was no mortality or serious disability. With 3 to 21-month follow-up in 11 cases, no death or serious disability was found, and the CT or MRI in 8 patients showed no recurrence. Conclusion The telovelar approach can provide adequate exposure to remove the lesion in the fourth venticle. The inferior vermis need not be incised, so a minimum amount of brain tissue was injured, and postoperative complication is decreased.