【摘要】 目的介绍一种经小脑扁桃体延髓沟入路切除枕骨大孔区、小脑扁桃体延髓沟内、Luschka孔区及第四脑室内肿瘤的方法。方法在熟悉小脑延髓沟显微解剖结构的基础上,临床上经此沟入路切除肿瘤7例。并对3例典型病例举例说明。结果小脑扁桃体延髓沟的显微解剖结构可以分为小脑扁桃体间隙和蚓垂扁桃体间隙两个部分。此沟的底由脉络膜、下髓帆和侧孔壁组成,也是第四脑室的顶。后壁由小脑扁桃体、枕大池组成,外侧壁有第Ⅸ、Ⅹ、Ⅺ、Ⅻ对颅神经,内含小脑后下动脉及其分支和小脑延髓静脉。可分3种方式打开此沟的底,进入第四脑室。2例枕大孔区肿瘤突出于此沟内完全切除;其中1例小脑半球毛细胞型胶质瘤经此入路全切除。4例髓母细胞瘤中2例经此沟底打开第四脑室全切除肿瘤,2例近全切除,1例第四脑室内室管膜瘤经此沟底打开第四脑室全切除肿瘤。结论后正中开颅、经小脑扁桃体延髓沟入路可以获得一个良好的手术野,为切除位于此沟内肿瘤、枕大孔区肿瘤、Luschka孔区肿瘤以及第四脑室内肿瘤提供了一个新的途径,还可以避免因切开小脑蚓部和切除小脑扁桃而产生的并发症。更多还原

【Abstract】 Objective To introduce a transcerebellomedullary fissure approach to remove the tumors located in the foramen of magnum, cerebellomedullary fissure, foramen of Luschka and the fourth ventricle. Methods After reviewing the micro-anatomy of the cerebellomedullary fissure, 7 patients were operated via transcerebellomedullary fissure approach. 3 operations were presented in details. Results Transcerebellomedullary fissure includes two components: uvulonsillar and medullotonsillar spaces. The bottom of the fissure is formed by inferior medullary velum, tela charoidea and the wall of the foramen of Luschka, that is right the roof of the fourth ventricle, the posterior wall of the fissure contents tonsil and the foramen of magnum. The lateral wall includes the Ⅸ,Ⅹ,Ⅺ and Ⅻ cranial nerves. Posterior inferior cerebellar artery and its branches and cerebellar medullary vein are also in this fissure. Three approaches can be used to cut the bottom of the fissure to enter the fourth ventricle. 3 patients with tumors in the foramen of magnum were removed totally via this approach. Among them one cerebellar pilocytic astrocytoma was totally removed. 2 patients with medulloblastomas in the fourth ventricle were dissected completely. The other two remained a small piece adhered to the bottom of the fourth ventricle. Conclusion Transcerebellomedullary fissure approach yields a panoramic view to the foramen of luschka and the fourth ventricle without splitting the vermis and removing the tonsil. Using this approach we can avoid the complications such as cerebellar mutism, ataxia and the shake of the head and trunk.更多还原