小脑延髓裂入路切除第四脑室肿瘤

目的 探讨经小脑延髓裂入路显微手术切除第四脑室肿瘤的方法,进一步了解入路的解剖结构以及如何保护脑干,避免损伤小脑后下动脉和术后主要并发症的处理.方法 对我院自2002年12月至2004年12月接受手术治疗的8例经小脑延髓裂入路切除的第四脑室肿瘤患者进行了回顾性分析,总结手术技巧和经验.结果 所有患者肿瘤全切除6例,近全切除2例,全切率75%,均打通脑脊液循环通路.术后全部清醒,无死亡.术后肿瘤复发1例,术后出现脑积水1例,行侧脑室-腹腔分流治疗.结论 经小脑延髓裂入路切除第四脑室内肿瘤,不需切开小脑下蚓部.可清楚地暴露导水管口、闩部及脑室侧壁,不损伤任何小脑组织.切除肿瘤过程中注意保护小脑后下动脉及其分支,注意区分肿瘤组织和脑干,与延髓呼吸中枢粘连紧密的肿瘤不必强行切除,有助于提高手术成功率,减少损伤.

Resection of Fourth Ventricle Tumors Through Transcerebel lomedullary Fissure Approach

Objective To investigate microsurgical treatment for the 4th ventricle tumors, and how to separate the tumor , how to protect brain stem and posterior inferior cerebellar artery, To get more knowledge about the microanatomy of transcerebellomedullary fissure approach. Method 8 cases forth ventricle tumors that have been operated transcerebellomedullary fissure approach in our department from December 1999 to December 2004 were analyzed retrospectively. The experience and skill of these operation were concluded, too. Results Cerebral aqueduct obstruction were solved in all 8 patients, 6 cases underwent total resection and 2 cases subtotal resection. Total resection rate were 75%. All patients were conscious after surgery, no dead, Tumor reoccur in 1 patient, 1 patients suffered postoperative hydrocephalus and was cured by ventriculoperitoneal shunt. Conclusions The transcerebellomedullary fissure approach can provide a panoramic view between the two lateral recesses and from obex to aqueduct without excision of neural tissue. PICA and its branches should be protected during the operation, The extent of tumor removal should be weighed with the possible risk of complication, especially with tumors adherent to the brainstem.