摘要：

目的 分析不同术式治疗颅后窝非实质型血管母细胞瘤效果，以探讨合理手术方式。方法 共61 例颅后窝非实质型血管母细胞瘤患者，分为正中入路开放枕骨大孔和寰椎组、正中入路不开放枕骨大孔和寰椎组、旁正中入路开放枕骨大孔和寰椎组、旁正中入路不开放枕骨大孔和寰椎组、乙状窦后入路组，评价手术疗效和术后并发症发生率。结果 61 例患者中手术全切除56 例（91.80%）、部分切除5 例（8.20%）。43 例有脑积水的患者术后脑积水缓解率达79.07%（34/43）。术后并发症以颅内感染最为多见，占22.95%（14/61），开放枕骨大孔和寰椎并回纳骨瓣（6/8）、开放枕骨大孔和寰椎不回纳骨瓣（25%）、不开放枕骨大孔和寰椎并回纳骨瓣（6.90%）、不开放枕骨大孔和寰椎不回纳骨瓣（1/4）患者颅内感染发生率差异具有统计学意义（Z = 16.269，P = 0.001），其中以不开放枕骨大孔和寰椎并回纳骨瓣者颅内感染发生率最低（P = 0.002，0.008，0.041）。结论 颅后窝非实质型血管母细胞瘤应在术者经验和患者病情允许的情况下，尽量选择不开放枕骨大孔和寰椎并回纳骨瓣的方式，以减少术后并发症。

关键词: 血管母细胞瘤, 颅窝, 后, 显微外科手术, 手术后并发症

Abstract:

Objective  The article analyzed the curative effect of different surgical treatments for non-solid hemangioblastoma in posterior cranial fossa to explore reasonable operation method.  Methods  Clinical data of 61 patients with non-solid hemangioblastoma who underwent surgeries in Tianjin Huanhu Hospital during July 2007 and June 2014 were retrospectively analyzed. According to surgical approaches and the situation of foramen magnum and atlas, these patients were divided into 5 groups: midline approach opening foramen magnum and atlas (Group A), midline approach without opening foramen magnum and atlas (Group B), paramedian approach opening foramen magnum and atlas (Group C), paramedian approach without opening foramen magnum and atlas (Group D), retrosigmoid approach (Group E). By collecting clinical symptoms, imaging findings, surgical records and postoperative complications, the surgical results and occurrence of postoperative complications were summarized and reasonable operation method was discussed.  Results  Among 61 patients, total resection was achieved in 56 cases (91.80%), and partial resection was achieved in 5 cases (8.20% ). The postoperative remission rate of 43 cases with hydrocephalus was 79.07% (34/43). Intracranial infection was the most common postoperative complication, accounting for 22.95% (14/61). There was significant difference in occurrence rate of intracranial infection among 4 subgroups: opening or not opening the foramen magnum and atlas with or without restoring bone flap (Z = 16.269, P = 0.001). In the subgroup of not opening foramen magnum and atlas with restoring bone flap, the infection rate, which accounted for 6.90% (2/29), was the lowest.  Conclusions  The surgical treatment options for non-solid hemangioblastoma in posterior fossa should be done according to patients' condition, and performed by a professional group. If conditions allow, not to open the foramen magnum and atlas, as well as intraoperative restoring bone flap should be chosen as far as possible, so as to reduce the occurrence of postoperative complications.

Key words: Hemangioblastoma, Cranial fossa, posterior, Microsurgery, Postoperative complications