OBJECTIVE: To study the therapeutic effects of microsurgery on medulloblastoma and the related points in children. METHODS: A retrospective review was conducted in 27 children with medulloblastoma confirmed pathologically. All the patients had transcerebellomedullary fissure and inferior vermis approach to the fourth ventricle. All the patients underwent craniotomy and the tumors were removed under the microscope. RESULTS:Tumors were totally resected in 22 cases ( 81.5% ) and subtotally removed in 5 cases ( 18.5% ) with microsurgical precedures. After the operation, neurological symptoms were improved in 26 patients and deteriorated in 1. No severe operative complications occurred and no patient died from operation. The cerebral aqueduct reopened in 26 cases, and Torkilsen's shunt was carried out at the same time in 1 case. The tumor was located in the cerebellar vermis in 6 cases, fourth cerebral ventricle in 9 cases, and cerebellar hemisphere in 1 case, and occurred in both the cerebellar vermis and fourth cerebral ventricle in 11 cases. The blood supply of tumors was provided by branches of the posterior inferior cerebellar artery in 19 cases. Complete follow up information was obtained in 25 patients for a period of 5 months to 3 years and 4 months. During the follow up, 25 patients received postoperative irradiation. Of them, 2 patients died of relapse or metastasis between 13 months and 3 years after the initial surgery, and the remainder recovered. CONCLUSIONS: A clear understanding of the microanatomy of the tumor and its adjacent tissue and structure is advantageous to the removal of tumor. Microsurgery is effective and safe for medulloblastoma excision. For total removal of the tumour, due care to safeguard the posterior inferior cerebellar artery and its branches, avoiding the bin stem and the base of the fourth ventricle injury, and relieveing obstruction of the mesencephalic aqueduct can decrease the incidence of relapse and metastasis and improve patients' survival period."/>
儿童髓母细胞瘤显微手术治疗
Abstract：OBJECTIVE: To study the therapeutic effects of microsurgery on medulloblastoma and the related points in children. METHODS: A retrospective review was conducted in 27 children with medulloblastoma confirmed pathologically. All the patients had transcerebellomedullary fissure and inferior vermis approach to the fourth ventricle. All the patients underwent craniotomy and the tumors were removed under the microscope. RESULTS:Tumors were totally resected in 22 cases ( 81.5% ) and subtotally removed in 5 cases ( 18.5% ) with microsurgical precedures. After the operation, neurological symptoms were improved in 26 patients and deteriorated in 1. No severe operative complications occurred and no patient died from operation. The cerebral aqueduct reopened in 26 cases, and Torkilsen's shunt was carried out at the same time in 1 case. The tumor was located in the cerebellar vermis in 6 cases, fourth cerebral ventricle in 9 cases, and cerebellar hemisphere in 1 case, and occurred in both the cerebellar vermis and fourth cerebral ventricle in 11 cases. The blood supply of tumors was provided by branches of the posterior inferior cerebellar artery in 19 cases. Complete follow up information was obtained in 25 patients for a period of 5 months to 3 years and 4 months. During the follow up, 25 patients received postoperative irradiation. Of them, 2 patients died of relapse or metastasis between 13 months and 3 years after the initial surgery, and the remainder recovered. CONCLUSIONS: A clear understanding of the microanatomy of the tumor and its adjacent tissue and structure is advantageous to the removal of tumor. Microsurgery is effective and safe for medulloblastoma excision. For total removal of the tumour, due care to safeguard the posterior inferior cerebellar artery and its branches, avoiding the bin stem and the base of the fourth ventricle injury, and relieveing obstruction of the mesencephalic aqueduct can decrease the incidence of relapse and metastasis and improve patients' survival period.
