Department of Neurosurgery, the Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China.
J Craniofac Surg. 2023;34(2):607-610. doi: 10.1097/SCS.0000000000008883. Epub 2022 Aug 15.
In this 2-year retrospective analysis, 13 patients with fourth ventricle lesions who underwent microsurgical resection via the midline suboccipital keyhole telovelar approach were analyzed. This is the first study to investigate the surgical outcome and complications of using this approach to resect various types of lesions in the fourth ventricle. We aimed to clarify whether this approach has met its promise of lesion dissection. Three patients (23.1%) had intraoperative extraventricular drains. There were no immediate postoperative deaths. Gross total resection was achieved in 84.6% of the cases. The Fisher exact test showed there was no statistically significant correlation between lesion location, lesion size, brainstem invasion, and extent of resection. About two third (69.2%) of the cases were free of complications. New or worsening gait/focal motor disturbance (15.4%) was the most common neurological deficit in the immediate postoperative period. One patient (7.7%) had worse gait disturbance/motor deficit following surgical intervention. Two patients (15.4%) developed meningitis. Two patients (15.4%) required postoperative cerebrospinal fluid diversion after tumor resection, of these 2 patients, 1 (7.7%) eventually needed a permanent shunt. There were no cases of cerebellar mutism and bulbar paralysis. The median suboccipital keyhole telovelar approach provides relative wide access to resect most fourth ventricle tumors completely and with satisfactory results. In contrast, this requires the appropriate patient selection and skilled surgeons.
在这项为期 2 年的回顾性分析中，分析了 13 例经中线枕下小骨窗经穹窿间入路行显微切除术的第四脑室病变患者。这是首次研究使用该入路切除第四脑室各种类型病变的手术结果和并发症的研究。我们旨在阐明该入路是否符合其病变解剖的承诺。3 例（23.1%）患者在术中行额外脑室引流。无术后即刻死亡。84.6%的病例达到大体全切除。Fisher 确切检验显示，病变部位、病变大小、脑干侵犯和切除范围之间无统计学显著相关性。约三分之二（69.2%）的病例无并发症。新出现或恶化的步态/局灶性运动障碍（15.4%）是术后即刻最常见的神经功能缺损。1 例（7.7%）患者在手术干预后出现步态障碍/运动功能减退。2 例（15.4%）发生脑膜炎。2 例（15.4%）患者在肿瘤切除后需要术后脑脊液引流，其中 1 例（7.7%）最终需要永久性分流。无小脑缄默症和延髓性瘫痪病例。中位枕下小骨窗经穹窿间入路可提供相对广泛的入路，以完全切除大多数第四脑室肿瘤，并取得满意的结果。相比之下，这需要适当的患者选择和熟练的外科医生。
