Wisoff J H, Epstein F J
Neurosurgery. 1984 Nov;15(5):707-9. doi: 10.1227/00006123-198411000-00014.
The authors describe their experience with an unusual postoperative syndrome of pseudobulbar palsy occurring a few days after the extirpation of large midline vermian/4th ventricular tumors in children. The patients had a delayed onset of supranuclear cranial nerve palsies associated with emotional incontinence and lability that resolved over several weeks to months. It is postulated that retraction pressure on the medial cerebellum and split vermis is the operative insult responsible for edema that subsequently tracked along fiber pathways in the middle and superior cerebellar peduncles into the upper pons and midbrain. Modifications of operative technique to eliminate the need for retraction are presented.
作者描述了他们在儿童大型中线蚓部/第四脑室肿瘤切除术后几天出现的一种不寻常的假性延髓麻痹综合征的经验。患者出现核上性脑神经麻痹延迟发作，伴有情感失禁和情绪不稳定，数周至数月后症状缓解。据推测，内侧小脑和蚓部劈开处的牵拉力是导致水肿的手术损伤，随后水肿沿着小脑上脚和中脚的纤维通路蔓延至上脑桥和中脑。文中介绍了为消除牵拉力需求而对手术技术进行的改进。
