[Microsurgical treatment and prevention of postoperative complications for the fourth ventricle tumors in adults].

OBJECTIVE

To explore the microneurosurgical technique and prevention of postoperative complications for the fourth ventricle tumors in adults.

METHODS

We retrospectively analyzed the clinical data of 68 patients with the fourth ventricle tumors between August 2005 and August 2007 in Xiangya Hospital after microsurgical operation. Tumors were excised by inferior vermis cerebellar approach or cerebellomedullary fissure approach. The extent of tumor removal should take into consideration the possible injury of brain stem respiratory center, especially tumors adherent to the brain stem. Cerebral aqueduct obstructions were removed in all patients, suspending dura on the neck muscles during closing skull to eliminate scalp hydrops.

RESULTS

There were 58 total tumor excisions and 10 subtotal tumor excisions. No patient died and no suboccipital hydrops took place before discharge in this study. Postoperative symptomatic hydrocephalus was found in 10 patients, but it was cured by ventricle-abdomen shunt. Hemorrhage in tumor lumen happened in 4 patients, who received second microsurgery. Drugs were given to 8 patients with intracranial pneumatocele, 10 with intracranial infection, and 18 with upper gastrointestinal hemorrhage. Five patients out of the 16 tracheotomies recovered well by mechanical ventilation.

CONCLUSION

Protecting the life center of brain stem and dredging the aqueduct outlet completely were the key to surgical success. Therapeutic effect could be improved by adept microneurosurgical techniques after operation. The prognosis of patients may be improved by preventing complications actively and combined therapy after the operation.