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1、《中国神经肿瘤杂志》2011,9(3):189-193189·论著·儿童第四脑室肿瘤显微外科治疗及手术后并发症的预防江常震,吴喜跃,林志雄,王晨阳,康德智(福建医科大学附属第一医院神经外科,福建福州350005)【摘要】背景与目的:儿童第四脑室肿瘤术后易出现的枕部皮下积液或假性脑膜膨出、切口脑脊液漏、颅内感染等并发症。本文探讨儿童第四脑室肿瘤手术计划的制订,以提高手术疗效。方法:2006年5月以来26例第四脑室肿瘤患儿在切除肿瘤前均行右侧脑室-前额Ommaya囊安置;术中及术后通过Ommaya囊持续外引流;经膜髓帆入路手术切除儿童第四脑室
2、肿瘤。结果:所有患儿在切除肿瘤前均行右侧脑室-前额Ommaya囊安置;术中及术后通过Ommaya囊持续外引流;肿瘤全切23例,次全切除3例,无一例出现缄默症,本手术组无死亡病例。6例颅内感染者得到有效控制,无一例出现脑积水而需要行分流术,未出现一例枕部假性脑膜膨出及切口脑脊液漏等并发症。结论:多数儿童第四脑室肿瘤患者可经膜髓帆入路在不需要切开小脑蚓部的情况下予以肿瘤切除,仅少数患者为了充分显示肿瘤上极而切开小脑下蚓部。术前安置Ommaya囊术后持续外引流,可以有效地预防并发症的发生。关键词:第四脑室肿瘤;显微外科手术;Ommaya囊;侧脑
3、室外引流中图分类号:R739.41文献标识码:A文章编号:1726-8192(2011)03-0189-05MicrosurgeryofForthVentricleTumorsandthePreventionofPostoperativeComplicationsChang-zhenJiang,Xi-yueWu,Zhi-xiongLin,Chen-yangWang,De-zhiKangDepartmentofNeurosurgery,theFirstAffiliatedHospitalofFujianMedicalUniversity,F
4、uzhou350005,P.R.China【ABSTRACT】BACKGROUND&OBJECTIVE:Theimprovementofremovalextentandminimizingpostoperativecomplicationsarethegoalofneurosurgicaltreatmentofforthventricletumors.Inthisarticle,wediscussedthesurgicalplanningoftheresectionoffourthventricletumorsinchildren,and
5、toimprovetheeffectofsurgery.METHODS:Theclinicaldataof26patientswithforthventricletumors(sinceMay2006)resectedthroughtelovelarapproachwereretrospectiveanalyzed.RESULTS:Beforetumorresection,anOmmayareservoirwasplacedinsidetheventricularontherightforeheadinallpatients,whichw
6、asusedforintraoperativeandpostoperativeexternalCSFdrainage.Inallpatients,23casesreceivedtotalresection,3casesreceivedsubtotalresection,nomutismordeathwasseeninthisgroup.Sixpatientswithintracranialinfectionwaseffectivelycontrolled.Noventriculoperitoneal(VP)shuntwasneededbe
7、causeofhydrocephalus,andnopseudomeningoceleorleakageofcerebrospinalfluidwasfound.CONCLUSIONS:Mostpatientswithforth收稿日期:2011-08-24修回日期:2011-09-17ventricletumorscanberemovedthrough通讯作者:林志雄trans-telovelarapproachwithoutdissectionofCorrespondenceto:Zhi-xiongLinthevermiformpro
8、cessofcerebellum.TheTel:86-591-87982655E-mail:lzx1967@sina.comvermiformprocessofcerebellumwasdis