Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666, Japan.
Department of Plastic Surgery, Tokyo Woman's Medical University, Tokyo, Japan.
Childs Nerv Syst. 2023 Jun;39(6):1635-1639. doi: 10.1007/s00381-023-05941-0. Epub 2023 Apr 5.
Exceedingly refractory, pediatric anaplastic ependymoma in many cases requires multisurgical removal. The high risk of poor wound healing and CSF leakage especially at the posterior fossa make this tumor difficult to treat.
A 9-year-old girl has had 4th ventricular anaplastic ependymoma since the age of 3. She experienced tumor removal 8 times including 4 posterior fossa craniotomies because tumors were disseminated not only to the posterior fossa but also to the cerebral hemispheres. She also underwent a dermal graft using a free flap. She experienced CSF leaks and meningitis frequently because the wound healing was poor. We performed a dermal flap closure using a pedicle trapezius muscle flap with a plastic surgeon when we performed the 5th tumor removal.
We achieved complete wound closure in spite of broad deficiencies in subcutaneous and epidermal tissues. After that, recurrences of posterior fossa tumors presented within a short term, and tumor removal via an incision of a pedicle trapezius muscle flap was performed without recurrence of CSF leaks and meningitis.
For the first time, we are able to report on the efficacy of using the pedicle trapezius muscle flap for multisurgical removal of pediatric posterior fossa anaplastic ependymoma. The muscle flap was found to be effective because of the multiple surgeries expected, and the pedicle trapezius muscle flap was found to be resilient to multiple surgical procedures. Although advantageous, the dorsal scapular artery which is required for flap creation is actually difficult to harvest. Compared to a flee flap, the pedicle trapezius muscle flap maintains vascular supply. Furthermore, this technique has the possibility of being applied to defective dura mater closure that cannot be watertight due to multiple surgeries. However, it is very important to inform the patient's family not only about the improved efficacy of surgery, but also to raise awareness on consequential cosmetic issues.
在许多情况下，非常难治的小儿间变性室管膜瘤需要多次手术切除。由于后颅窝愈合不良和 CSF 漏的风险很高，特别是在后颅窝，使这种肿瘤难以治疗。
一名 9 岁女孩自 3 岁起患有第四脑室间变性室管膜瘤。她经历了 8 次肿瘤切除术，包括 4 次后颅窝开颅术，因为肿瘤不仅扩散到后颅窝，还扩散到大脑半球。她还接受了皮瓣游离移植。由于伤口愈合不良，她经常出现 CSF 漏和脑膜炎。当我们进行第 5 次肿瘤切除时，我们与整形外科医生一起使用带蒂斜方肌皮瓣进行皮瓣闭合。
尽管皮下和表皮组织广泛缺损，我们仍实现了完全伤口闭合。此后，后颅窝肿瘤短期内复发，通过带蒂斜方肌皮瓣切口进行肿瘤切除，无 CSF 漏和脑膜炎复发。
我们首次能够报告使用带蒂斜方肌皮瓣进行小儿后颅窝间变性室管膜瘤多次手术切除的疗效。由于预计需要多次手术，因此肌肉瓣是有效的，并且带蒂斜方肌瓣对多次手术具有弹性。尽管有优势，但为皮瓣创建所需的肩胛背动脉实际上很难采集。与皮瓣游离移植相比，带蒂斜方肌皮瓣保持了血管供应。此外，由于多次手术，该技术有可能应用于无法密闭的缺损硬脑膜闭合。然而，不仅要告知患者家属手术疗效的提高，还要提高对相关美容问题的认识，这一点非常重要。
