cerebellar vermis tumor resection

The cerebral palsy is the most common medulloblastoma, followed by astrocytoma. Curing disease: Indication Cerebellar sac tumor resection is applicable to: 1. Various types of tumors in the cerebellum. 2. The cerebellar sac tumor grows into the fourth ventricle and cerebellar hemisphere. Contraindications Patients who have been depleted are not suitable for surgery. Preoperative preparation If the intracranial pressure increases sharply before surgery, it is advisable to perform lateral cerebral puncture continuous drainage 2 to 3 days before surgery to reduce intracranial pressure and reduce intracranial stagnation to facilitate surgery. Surgical procedure 1. Incision: Most of the posterior cranial fossa is used to open the occipital foramen and the posterior arch of the atlas. If the tumor is very long to the upper end of the spinal canal, cervical laminectomy is still needed. 2. Incision of the dura mater to explore the tumor: Most of the medulloblastoma is located in the depth of the ankle, and the ankle is widened and bulged backward. In most cases, the tumor has protruded to the surface, or has protruded from the lower end of the ankle to the cisterna magna. The boundary is explored by the periphery of the tumor. 3. Resection of the tumor: Electrocoagulation into the tumor's blood vessels one by one, the supply of the tumor is mostly from the branches of the posterior cerebellar artery. These blood supply arteries were visualized under a surgical microscope and electrocoagulated and cut off when the artery entered the tumor. After the main body of the tumor is initially revealed, the tumor tissue is aspirated by the aspirator to shrink the tumor. During the process of tumor exploration and resection, because the tumor is located near the medulla, the operation should be extraordinarily detailed and careful, and the brain plate should not extend to the bottom of the fourth ventricle to avoid damage to the brain stem. Then peeled off from the edge of the tumor, carefully hemostasis, the upper part of the tumor was pulled from the bottom of the fourth ventricle, and the tumor was removed. After excision of the subject of the tumor, an enlarged and smooth bottom of the fourth ventricle is revealed. Further examination of the growth and infiltration of the tumor to the periphery is required. Sometimes the tumor has a small range of adhesion to the bottom of the fourth ventricle. It should be particularly meticulous in the separation. It is a nodular medulloblastoma, which can reach the gross resection of the tumor. The tumor is particularly large, and has been deep-rooted and infiltrated into the brainstem and cerebellar hemisphere. The tumor is treated as described above, and the tumor is inserted into the body of the fourth ventricle as much as possible to remove the pressure on the water conduit and restore the smooth circulation of the cerebrospinal fluid. purpose. The tumor tissue infiltrated into the brainstem can only properly absorb part of the tumor tissue within the tumor tumor body, and cannot exceed its boundary, so that the brain stem is directly damaged. If the fourth ventricle cerebrospinal fluid out of the way failed to get through, it must be supplemented with lateral ventricle-occipital large pool shunt. 4. The medulloblastoma surgery is difficult to achieve total tissue resection, but the tumor should be removed as thoroughly as possible. The less the residue, the better the effect. Intraoperative tumor cells fall off and can be spread along the cerebrospinal fluid circulation pathway. The cotton pad is used to block the large pool of the pillow, the surgical field is washed many times, and the blood of the fourth ventricle and the retrograde entry into the lower end of the water conduit is completely removed. 5. Place the drainage tube in the cisterna magna and make a closed drainage. 6. Close the incision. complication 1. Surgical operation sometimes involves the brainstem and the fourth ventricle, central circulatory dysfunction may occur, tracheotomy, assisted breathing and supportive therapy should be taken in time. 2. If the cerebrospinal fluid circulation obstruction fails to be relieved, the crisis of increased intracranial pressure may occur. 3. Postoperative silence can occur in children, the reason is not very clear. Most of them improved after a few weeks.