中华显微外科杂志
中華顯微外科雜誌
중화현미외과잡지
Chinese Journal of Microsurgery
2012年
5期
384-386
,共3页
沈军%罗靖%程宏伟%冯春国%王晓健%程宝春%肖瑾%赵亮%李庆新%吕波
瀋軍%囉靖%程宏偉%馮春國%王曉健%程寶春%肖瑾%趙亮%李慶新%呂波
침군%라정%정굉위%풍춘국%왕효건%정보춘%초근%조량%리경신%려파
第四脑室%小脑延髓裂入路%小脑下后动脉%内镜%神经电生理监测
第四腦室%小腦延髓裂入路%小腦下後動脈%內鏡%神經電生理鑑測
제사뇌실%소뇌연수렬입로%소뇌하후동맥%내경%신경전생리감측
Fourth ventricle%Cerebellomedullary fissure approach%Posterior inferior cerebellar artery%Endoscope%Neurophysiological monitoring
目的 探讨神经内镜辅助下经外侧壁型小脑延髓裂入路对第四脑室肿瘤的治疗效果.方法 回顾性分析14例第四脑室占位性病变患者的临床资料.所有患者均经外侧壁型小脑延髓裂入路进行手术治疗,对于向导水管深部发展的肿瘤暴露效果欠佳者,采用内镜辅助操作,术中辅以神经电生理监测及术中B超. 结果 病变全切除12例,近全切除1例,大部分切除1例.术后病理诊断:髓母细胞瘤4例,表皮样囊肿3例,室管膜瘤2例,血管母细胞瘤2例,脑膜瘤1例,海绵状血管瘤1例,星形细胞瘤1例.所有患者均恢复正常脑脊液循环通路,术前症状均无明显加重,无面瘫等神经核团损伤相关并发症发生,1例患者术后呼吸微弱给予呼吸机辅助后恢复正常.术后随访3 ～ 28个月,1例死亡,1例髓母细胞瘤复发. 结论 内镜辅助下经外侧壁型小脑延髓裂入路结合电生理监测及超声成像技术,能降低面瘫、听力减退等术后并发症的发生.
目的 探討神經內鏡輔助下經外側壁型小腦延髓裂入路對第四腦室腫瘤的治療效果.方法 迴顧性分析14例第四腦室佔位性病變患者的臨床資料.所有患者均經外側壁型小腦延髓裂入路進行手術治療,對于嚮導水管深部髮展的腫瘤暴露效果欠佳者,採用內鏡輔助操作,術中輔以神經電生理鑑測及術中B超. 結果 病變全切除12例,近全切除1例,大部分切除1例.術後病理診斷:髓母細胞瘤4例,錶皮樣囊腫3例,室管膜瘤2例,血管母細胞瘤2例,腦膜瘤1例,海綿狀血管瘤1例,星形細胞瘤1例.所有患者均恢複正常腦脊液循環通路,術前癥狀均無明顯加重,無麵癱等神經覈糰損傷相關併髮癥髮生,1例患者術後呼吸微弱給予呼吸機輔助後恢複正常.術後隨訪3 ～ 28箇月,1例死亡,1例髓母細胞瘤複髮. 結論 內鏡輔助下經外側壁型小腦延髓裂入路結閤電生理鑑測及超聲成像技術,能降低麵癱、聽力減退等術後併髮癥的髮生.
목적 탐토신경내경보조하경외측벽형소뇌연수렬입로대제사뇌실종류적치료효과.방법 회고성분석14례제사뇌실점위성병변환자적림상자료.소유환자균경외측벽형소뇌연수렬입로진행수술치료,대우향도수관심부발전적종류폭로효과흠가자,채용내경보조조작,술중보이신경전생리감측급술중B초. 결과 병변전절제12례,근전절제1례,대부분절제1례.술후병리진단:수모세포류4례,표피양낭종3례,실관막류2례,혈관모세포류2례,뇌막류1례,해면상혈관류1례,성형세포류1례.소유환자균회복정상뇌척액순배통로,술전증상균무명현가중,무면탄등신경핵단손상상관병발증발생,1례환자술후호흡미약급여호흡궤보조후회복정상.술후수방3 ～ 28개월,1례사망,1례수모세포류복발. 결론 내경보조하경외측벽형소뇌연수렬입로결합전생리감측급초성성상기술,능강저면탄、은력감퇴등술후병발증적발생.
Objective To investigate the therapeutic effect of the fourth ventricle tumors through lateral wall type of the transcerebellomedullary fissure approach under endoscope.Methods Clinical data of 14 cases with the fourth ventricle lesions were analyzed retrospectively.All the patients were treated by lateral wall type of the transcerebellomedullary fissure approach surgery.The endoscope was used if the lesions develop to the aqueduct and hard to be exposed.Both neurophysiological monitoring and intraoperative ultrasound were used regularly.Results Tumors were totally removed in 12 cases,subtotally in 1,and partially in 1.All the patients were diagnosed in postoperative histopathology,including 4 medulloblastoma,three epidermoid cyst,two ependymoma,two hemangioblastoma,one meningioma,one cavernous hemangioma and 1 astrocytoma.Hypopnea occurred immediate after operation in 1 patient.Ventilatory support was performed by Ventilator,and the respiration was restored 1 day later.Normal cerebrospinal fluid circulation was return in all cases.Neither aggravation of preoperative symptoms nor nuclei injury related complication had been found.The follow-up interval between 3 months to 28 months,one patient was dead with unexplained,and 1 medulloblastoma patient was relapse.Conclusion Lateral wall type of the transeerebellomedullary fissure approach,under endoscope,combined with the usage of neurophysiological monitoring and intraoperative ultrasound,can degrade the surgical related complications such as facial palsy and amblyacousia.
