Microsurgical Treatment Of Brain Stem Tumor And Peripheral Brainstem Tumor

Objective:we select 60 cases of brain stem tumor and peripheral brain stem tumor with complete data from 1993 to 2009 in Jilin University-Japan Friendship Hospital. For its treatment methods and results were retrospectively analyzed. Detailed from clinical, radiological examination and pathologic types, surgical operation indication, purpose, Surgical approaches, surgical operation methods and techniques, perioperative management, postoperative adjuvant therapy and prognosis of operation analysis of success.Methods: All 60 cases of patients were treated by microsurgery.56 cases of patients were taken suboccipital midline approach and tumors were in the medulla oblongata and neck, dorsal medulla, dorsal pontine segment, cerebellar vermis and fourth ventricle。2 cases in the midbrain rear, the top lateral pontine tumor with occipital transtentorial approach (Poppen approach); the other two cases of pontine tumor is located in the side of the front side, using the suboccipital retrosigmoid approach for resection. 29 patients with serious preoperative hydrocephalus have done ventricle external drainage 3-5 days before operating or in the same time。This group of patients with brain stem tumor depend on the results of discharge,while patients with peripheral brain stem tumor depend on results of discharge and follow up results。Discharged results were divided into:①good: that a patient's consciousness is fully aware, without any neurological deficits, no obvious symptoms of mental retardation and mental;②mild disability: a mild neurological impairment or mild mental decline or psychiatric symptoms,however, fully self-care;③severely disabled: a serious neurological disorder or disturbance of consciousness, need further clinical care or others, help;④death. Discharge results in the statistical analysis, the good and miled disability as a good prognosis, severe disability and death will be classified as poor prognosis group, the final statistical outcomes were good rate and poor prognosis rate.Results:1 In 16 patients with brain stem tumors, total removal of tumor in 12 patients (75%), tumors which have subtotal resection in 4 cases;○2 Pathologically confirmed 7 cases of astrocytoma, 3 cases of ependymoma, 3 cases of hemangioblastoma, 1 case of glioblastoma, and 2 cases of brain stem metastasis;○3 Neurological function has improved in 12 cases after operating, 1 case of mild disability, severe disability in 1 case, 2 patients have dead(1 case died of renal failure, another died of respiratory failure);○4 Prognosis is good for 81.3%.peripheral brain stem tumors:○1 In 44 cases of brain stem tumors ,tumor total removal in 35 cases, Subtotal resection in 9 cases。○2 Pathological examination confirmed 35 cases of cerebellar vermis medulloblastoma, 6 cases of cerebellar vermis astrocytoma, 2 cases of choroid plexus tumor and 1 case of hemangioblastoma;○3 Good postoperative neurological function in 36 cases, 5 cases of mild disability, severe disability in 2 cases, 1 died(Died of tumor recurrence, intracranial infection);○4 Prognosis is good for 93.2%.○5 44 patients were followed-up,17 cases were followed up for 3-54 months, mean follow up time is about 25 months. In 17 patients, 4 patients died because of tumor recurrence. Survival of the 13 cases, there is one case of cerebellar vermis medulloblastoma was found sacral metastasis after 6 months; 3 patients can work and study 6 months later after surgery, but it can not last longer (3-4 hours ), only occasional headache; the other patients after 6 months can work and study, living entirely herself. The longest follow-up 1 was cerebellar vermis medulloblastoma, has been 54 months, no tumor recurrence, no nervous system dysfunction.Conclusion:1) In the correct choice of surgical indications, based on using rich knowledge of microanatomy and excellent surgical skills, the operation of the brainstem and peripheral brain stem tumors of microsurgery effect is satisfactory; 2) According to different parts of tumor to select a different surgical approach can reduce neurological injury; 3) The base is located in the brain stem tumor, its brain outside the main conflict to exogenous tumor surgery should be total removal of tumor, and for endogenous or endogenous tumor localized in the brain stem should be as many as possible to remove the tumor; 4) peripheral brain stem tumors usually impede the cycle paths, except for surgery to remove the tumor as much as possible, we must also try to get through cerebrospinal fluid circulation path, removing hydrocephalus; 5) If the tumor is closely related with the brain stem, we can not be forcibly removed to avoid serious brain stem injury caused by neurological dysfunction, even death, the residual tumor after operation with adjuvant radiotherapy can extend survival of patients.6) The correct perioperative treatment is essential to the success of surgery.