Shimoji Kazuaki, Miyajima Masakazu, Karagiozov Kostadin, Yatomi Kenji, Matsushima Toshio, Arai Hajime
Department of Neurosurgery, Juntendo Nerima Hospital, 3-1-10 Takanodai Nerima, Tokyo, 177-8521, Japan.
Childs Nerv Syst. 2009 Oct;25(10):1221-8. doi: 10.1007/s00381-009-0835-5. Epub 2009 Apr 10.
Within the existing consensus for the best management of pediatric infratentorial ependymomas (PIE), surgery is the most important stage, where complete removal should be the perfect aim, before complementing it with chemo- or radiotherapy. That, however, remains a challenge even for the most skillful surgeons because of the vicinity of important brainstem and cranial nerve structures involved and is particularly difficult in lateral extensions.
The paper analyzes the current trends of PIE treatment with emphasis on resection difficulties created by lateral extensions. Anatomical analysis and clinical application of the cerebellomedullary fissure dissection has created specific approaches, providing safe route to the lateral recess and cerebellopontine area by dividing safely tenia and tonsils and biventer lobes retraction.
Bilateral and unilateral approaches have been developed. This approach prevents the damage of transvermian access and the resulting cerebellar mutism in some cases. Indications, technique and benefits of transcerebellomedullary fissure types of approaches are discussed.
在小儿幕下室管膜瘤（PIE）最佳治疗的现有共识中，手术是最重要的阶段，在此阶段应争取实现完全切除，之后再辅以化疗或放疗。然而，即便对于最熟练的外科医生而言，这仍是一项挑战，因为病变部位紧邻重要的脑干和颅神经结构，而对于向外侧扩展的肿瘤，手术难度尤其大。
本文分析了PIE治疗的当前趋势，重点关注向外侧扩展所带来的切除困难。对小脑延髓裂解剖的分析及临床应用产生了特定的手术入路，通过安全地分开 tenia 和扁桃体以及牵开二腹叶，为外侧隐窝和桥小脑区提供了安全的手术路径。
已开发出双侧和单侧手术入路。这种入路可避免经小脑蚓部入路造成的损伤以及某些情况下由此导致的小脑缄默症。文中讨论了经小脑延髓裂入路的适应症、技术及优势。
