To explore the microsurgical methods and techniques for the resection of medulloblastoma (MDB) in children with cerebellomedullary fissure (CMF) approach.

The clinical data of 32 children with MDB treated by minimally invasive microsurgery with CMF approach from January 2011 to December 2019 were retrospectively analyzed. Unilateral CMF approach was used in 28 patients and bilateral CMF approach was used in 4 patients.

There were 29 cases (90.6%) with total resection and 3 cases (9.4%) with subtotal resection. There was no operation related death and no permanent cerebrospinal fluid leakage. One patient suffered from cerebellar mutism and recovered completely 1 month later. All patients had their aqueduct opened, except for 2 patients who needed ventriculoperitoneal shunt because hydrocephalus was not relieved or aggravated, the symptoms and signs of intracranial hypertension were improved. After operation, 2 patients developed posterior cranial nerve palsy, 5 patients had supratentorial and inferior subdural effusion, which were cured by subcutaneous catheterization and pressure bandage; 3 patients had intracranial infection, 3 patients had ataxia aggravation, 1 patient had meningocele and 1 patient had dyspnea, which were cured by symptomatic treatment. The median follow-up time was 37 months (3-81 months), 27 patients returned to normal life, and 5 patients still had different degrees of neurological dysfunction.

The CMF approach is a safe and effective minimally invasive surgical approach for the removal of MDB. Mastering the methods and skills of CMF approach and MDB microsurgery, and adopting exquisite minimally invasive neurosurgical techniques are helpful to improve the total resection rate and surgical efficacy of MDB.