儿童第四脑室-小脑脚-脑干区肿瘤的手术治疗

目的 研究第四脑室-小脑脚-脑干区肿瘤的形态学特点，以及安全地切除此部位肿瘤的手术方法。方法 儿童（15岁以下）第四脑室-小脑脚-脑干区肿瘤（室管膜瘤和星形细胞瘤）23例。术前头颅MRI证实瘤体起源于小脑脚或侧隐窝，分别向第四脑室，脑干，CPA和斜坡生长。采用枕下正中外侧拐入路，术中分区域切除肿瘤，结果 全切除肿瘤12例，近全切除9例，大部切除2例，无手术死亡，术后病理证实室管膜瘤13例，恶性室管膜瘤2例，星形细胞瘤8例。结论 起源于小脑脚或侧隐窝的肿瘤，以脑干为中心呈半弧形生长，肿瘤侵袭范围包括第四脑室，小脑脚，脑干，CPA和斜坡，合适的手术入路和术中分区域切除肿瘤的技术，可以做到安全地全切除和/或近全切除肿瘤。

Surgical treatment of tumors of the fourth ventricle-brain stem-inferior cerebellar peduncle in children

Objective To study the morphology and surgical outcome of the tumor involved the fourth ventricle, brain stem, inferior cerebellar peduncle and the cerebellar pontine(CP)angle. Methods 23 children(age below 15 years)with the tumor(ependymomas and astrocytomas)of the fourth ventricle brainstem inferior cerebellar peduncle were operated on using the median lateral approach.Preoperative MRI showed that the tumors involved the fourth ventricle, brainstem, cerebellar peduncles, CP angle and/or the clivus areas.Results 12 cases got the tumors removed totally, 9 cases removed subtotally and 2 cases removed partially.The histological diagnosis was ependymoma in 13 cases, malignant ependymoma in 2 cases and astrocytoma in 8 cases.Conclusions The tumors originated from the inferior cerebellar peduncle or the lateral recess can invade the fourth ventricle, cerebellar hemisphere, brain stem CP angle and/or clivus.The suboccipital median lateral approach can provide a wider operative field.We can remove this kind of tumor totally or subtotally with rave complication.