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中华脑科疾病与康复杂志(电子版) ›› 2020, Vol. 10 ›› Issue (05) : 298 -304. doi: 10.3877/cma.j.issn.2095-123X.2020.05.010

所属专题: 文献

颅内肿瘤

髓母细胞瘤的手术入路选择
陈立华1, 陈文锦1, 夏勇1, 张洪钿1, 孙恺1, 徐如祥1,()   
  1. 1. 610072 成都,四川省医学科学院·四川省人民医院神经外科
  • 收稿日期:2020-10-18 出版日期:2020-10-15
  • 通信作者: 徐如祥

Selection of surgical approaches for medulloblastoma

Lihua Chen1, Wenjin Chen1, Yong Xia1, Hongtian Zhang1, Kai Sun1, Ruxiang Xu1,()   

  1. 1. Department of Neurosurgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Chengdu 610072, China
  • Received:2020-10-18 Published:2020-10-15
  • Corresponding author: Ruxiang Xu
引用本文:

陈立华, 陈文锦, 夏勇, 张洪钿, 孙恺, 徐如祥. 髓母细胞瘤的手术入路选择[J]. 中华脑科疾病与康复杂志(电子版), 2020, 10(05): 298-304.

Lihua Chen, Wenjin Chen, Yong Xia, Hongtian Zhang, Kai Sun, Ruxiang Xu. Selection of surgical approaches for medulloblastoma[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2020, 10(05): 298-304.

脑干和小脑是进入第四脑室的主要手术障碍。小脑延髓裂(CMF)是小脑扁桃体、蚓部与延髓之间天自然的解剖裂隙,经CMF入路沿自然无血管平面的解剖,通过切除、切开脉络膜和下髓帆,使手术暴露和工作范围最大化的同时避免了小脑蚓部切开,联合C1后弓切除,改善了第四脑室上部的上下方向的暴露,提供额外的手术路径。当髓母细胞瘤已经通过第四脑室正中孔建立了肿瘤走廊的手术路径时,明显扩大术野的显露范围,并减轻了对小脑扁桃体的牵拉。本文围绕CMF入路的设计理念、开放类型、显露范围和入路的优缺点综述如下。

The brain stem and cerebellum are the main surgical barriers to the fourth ventricle. Cerebellar medullar fissure (CMF) is the natural anatomic fissure among amygdala, cerebellum vermis and medulla oblongata. The CMF operative approach vianatural avascular flat anatomy, thus by excision, incision under the choroid and pith sail, to maximize exposure and scope of work at the same time avoid the cerebellar vermis incision, joint C1 arch after resection, could improved the upper part of the fourth ventricle and direction of exposure, and provide additional surgery path. When medulloblastoma had established a surgical path through the tumor corridor through the median foramen of the fourth ventricle, the exposure of the surgical field was significantly expanded and the traction of the cerebellar tonsils was reduced. In this paper, the design concept, open type, exposure range and advantages and disadvantages of CMF approach are summarized as follows.

表1 经小脑延髓裂入路与其他入路的不同特点比较
[1]
Matsushima T, Abe H, Kawashima M, et al. Exposure of the wide interior of the fourth ventricle without splitting the vermis: Importance of cutting procedures for the tela choroidea[J]. Neurosurg Rev, 2012, 35(4): 563-571; discussion 571-562.
[2]
Matsushima T, Rutka J, Matsushima K. Evolution of cerebellomedullary fissure opening: its effects on posterior fossa surgeries from the fourth ventricle to the brainstem[J]. Neurosurg Rev, 2020, Online ahead of print.
[3]
Mussi AC, Matushita H, Andrade FG, et al. Surgical approaches to IV ventricle--anatomical study[J]. Childs Nerv Syst, 2015, 31(10): 1807-1814.
[4]
Mercier P, Bernard F, Delion M. Microsurgical anatomy of the fourth ventricle[J]. Neurochirurgie, 2018, Online ahead of print.
[5]
Kyoshima K, Kobayashi S, Gibo H, et al. A study of safe entry zones via the floor of the fourth ventricle for brain-stem lesions. Report of three cases[J]. J Neurosurg, 1993, 78(6): 987-993.
[6]
Bogucki J, Gielecki J, Czernicki Z. The anatomical aspects of a surgical approach through the floor of the fourth ventricle[J]. Acta Neurochir (Wien), 1997, 139(11): 1014-1019.
[7]
Tomasello F, Conti A, Cardali S, et al. Telovelar approach to fourth ventricle tumors: Highlights and limitations[J]. World Neurosurg, 2015, 83(6): 1141-1147.
[8]
Tanriover N, Ulm AJ, Rhoton AL Jr, et al. Comparison of the transvermian and telovelar approaches to the fourth ventricle[J]. J Neurosurg, 2004, 101(3): 484-498.
[9]
Jean WC, Abdel Aziz KM, Keller JT, et al. Subtonsillar approach to the foramen of Luschka: an anatomic and clinical study[J]. Neurosurgery, 2003, 52(4): 860-866; discussion 866.
[10]
Matsushima T, Fukui M, Inoue T, et al. Microsurgical and magnetic resonance imaging anatomy of the cerebello-medullary fissure and its application during fourth ventricle surgery[J]. Neurosurgery, 1992, 30(3): 325-330.
[11]
Mussi AC, Rhoton AL Jr. Telovelar approach to the fourth ventricle: microsurgical anatomy[J]. J Neurosurg, 2000, 92(5): 812-823.
[12]
Deshmukh VR, Figueiredo EG, Deshmukh P, et al. Quantification and comparison of telovelar and transvermian approaches to the fourth ventricle[J]. Neurosurgery, 2006, 58(4 Suppl 2): ONS-202-206; discussion ONS-206-207.
[13]
Rhoton AL Jr. Cerebellum and fourth ventricle[J]. Neurosurgery, 2000, 47(3 Suppl): S7-S27.
[14]
Han S, Wang Z, Wang Y, et al. Transcerebellomedullary fissure approach to lesions of the fourth ventricle: less is more?[J]. Acta Neurochir (Wien), 2013, 155(6): 1011-1016.
[15]
Qiu BO, Wang Y, Wang W, et al. Microsurgical management of pediatric ependymomas of the fourth ventricle via the trans-cerebellomedullary fissure approach: a review of 26 cases[J]. Oncol Lett, 2016, 11(6): 4099-4106.
[16]
Gök A, Alptekin M, Erkutlu I. Surgical approach to the fourth ventricle cavity through the cerebellomedullary fissure[J]. Neurosurg Rev, 2004, 27(1): 50-54.
[17]
Liu R, Kasper EM. Bilateral telovelar approach: a safe route revisited for resections of various large fourth ventricle tumors[J]. Surg Neurol Int, 2014, 5: 16.
[18]
Kellogg JX, Piatt JH Jr. Resection of fourth ventricle tumors without splitting the vermis: the cerebellomedullary fissure approach[J]. Pediatr Neurosurg, 1997, 27(1): 28-33.
[19]
陈立华,徐如祥,魏群,等.小脑延髓裂入路在第四脑室和脑干背侧肿瘤手术中的临床应用[J].临床神经外科杂志, 2017, 14(5): 360-365.
[20]
Tayebi Meybodi A, Lawton MT, Tabani H, et al. Tonsillobiventral fissure approach to the lateral recess of the fourth ventricle[J]. J Neurosurg, 2017, 127(4): 768-774.
[21]
Lawton MT, Quiñones-Hinojosa A, Jun P. The supratonsillar approach to the inferior cerebellar peduncle: anatomy, surgical technique, and clinical application to cavernous malformations[J]. Neurosurgery, 2006, 59(4 Suppl 2): ONS244-51; discussion ONS251-2.
[22]
Jamshidi AO, Priddy B, Beer-Furlan A, et al. Infradentate approach to the fourth ventricle[J]. Oper Neurosurg (Hagerstown), 2019, 16(2): 167-178.
[23]
Piatt JH, Kellogg JX. A hazard of combining the infratentorial supracerebellar and the cerebellomedullary fissure approaches: cerebellar venous insufficiency[J]. Pediatr Neurosurg, 2000, 33(5): 243-248.
[24]
Hermann EJ, Rittierodt M, Krauss JK. Combined transventricular and supracerebellar infratentorial approach preserving the vermis in giant pediatric posterior fossa midline tumors[J]. Neurosurgery, 2008, 63(1 Suppl 1): ONS30-5; discussion ONS35-7.
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