CAJ | 학술논문

目的探讨经小脑延髓裂(CMF)人路显微手术治疗儿童第四脑室肿瘤的方法,提高手术治疗效果.方法对17例2～14岁原发第四脑室肿瘤患儿,采用枕下正中切口、横窦下颅骨开窗骨瓣成形及经小脑延髓裂入路显微切除肿瘤,其中广泛型CMF切开12例,外侧壁型切开3例,外侧隐窝切开2例；硬脑膜严密缝合或修补,骨瓣复位并固定.结果肿瘤全切除15例,次全切除2例,病理结果髓母细胞瘤9例,室管膜瘤5例,星形细胞瘤3例,无围手术期死亡发生.术后15例患儿症状体征均明显改善或消失,无新发共济失调、震颤、肌张力降低及脑积水、小脑缄默综合征等并发症.复发2例,均为髓母细胞瘤,2年后死亡1例.结论经小脑延髓裂人路能较好地显露儿童第四脑室肿瘤,可减少因切开小脑蚓部和向侧方牵拉损伤小脑所导致的并发症发生.
목적 탐토경소뇌연수렬(CMF)인로현미수술치료인동제사뇌실종류적방법,제고수술치료효과.방법 대17례2～14세원발제사뇌실종류환인,채용침하정중절구、횡두하로골개창골판성형급경소뇌연수렬입로현미절제종류,기중엄범형CMF절개12례,외측벽형절개3례,외측은와절개2례；경뇌막엄밀봉합혹수보,골판복위병고정.결과 종류전절제15례,차전절제2례,병리결과수모세포류9례,실관막류5례,성형세포류3례,무위수술기사망발생.술후15례환인증상체정균명현개선혹소실,무신발공제실조、진전、기장력강저급뇌적수、소뇌함묵종합정등병발증.복발2례,균위수모세포류,2년후사망1례.결론 경소뇌연수렬인로능교호지현로인동제사뇌실종류,가감소인절개소뇌인부화향측방견랍손상소뇌소도치적병발증발생.
Objective To investigate the clinical effects and surgical techniques of the transcerebellomedullary fissure (trans-CMF)approach to resect the fourth ventricle tumors in children.Methods Seventeen children with the fourth ventricle neoplasm underwent resection via suboccipital medianposterior fossa cranioplasty and trans-CMF approach,hereinto extensive (aqueduct) opening in 12,lateral wall opening in 3 and lateral recess opening in 2 cases.Results Total tumor resection was achieved in 15,and subtotal resection in 2.No death happened in this group.There were no new neurological deficits.Symptoms such as headache,vomiting,ataxia and vision were improved or disappeared after operation.None of them presented mutism.Conclusions The trans-CMFb approach can provide a sufficient exposure to resect the fourth ventricle neoplasm in children without incision of cerebellar inferior vermis or injury to cerebellar tissues.