Halil İbrahim SEÇER, Özkan TEHLİ, BÜLENT DÜZ, YUSUF İZCİ, METİN KAPLAN, Engin GÖNÜL

4. ventrikül tümörlerinin transvermian yolla cerrahi tedavi sonuçları

Amaç: Bu çalışmada, 1996-2006 yılları arasında transvermian yaklaşım ile opere edilip histopatolojik tanıları konulmuş dördüncü ventrikül tümörlü 26 olgunun kayıtları retrospektif olarak incelendi. Gereç ve Yöntem: Olguların yaşları 5 ile 61 arasında değişmekte olup ortalama yaş 24'dü. 6 olgu pediatrik yaş gurubundaydı. Olguların 15'i erkek, 11'i kadındı. Hastaların hepsine bilgisayarlı beyin tomografisi ve manyetik rezonans görüntüleme (MRG) tetkikleri ameliyat öncesi yapıldı. Olguların tamamında hidrosefali mevcuttu. Olguların 7 sine preoperatif dönemde kliniğimizde ya da ilk müracaat ettiği çevre hastanelerde eksternal ventrikül drenajı uygulandı. Olgular postoperatif 3 er aylık periodlarla MRG ile takip edildi. Takip süremiz 12 ile 72 ay arasında değişmekte olup ortalama 19,3 aydır. Olguların tümü konkord pozisyonda, suboksipital kraniektomi sonrası, inferior vermian yaklaşımla opere edildiler. Bulgular: Cerrahiye bağlı mortalite olmadı. Bir olguda parsiyel serebellar eksizyon yapıldı. Postoperatif dönemde hiçbir olguya reoperasyon uygulanmadı, ventriküloperitoneal şant aplikasyonu yapılmadı. Sonuç: Transvermian yaklaşımla opere edilen olgularda davranış bozuklukları, mutizm ve orofaringeal apraksi gibi defisitler oluştuğu bildirilse de klasik orta hat yaklaşımı ile 4. ventrikül tümörlerinin eksizyonu etkili, kontrollü, rahat ve kolay bir yöntemdir.

The results of the surgical treatment of 4th ventricle tumors with transvermian approach

Objective: In this study, 26 patients with fourth ventricle tumors, operated with transvermian approach and diagnosed hsitopatologically between 1996-2006 were analyzed retrospectively. Materials and Methods: Patients' mean age was 24 years (5-61), 15 of them were male. Whole patients computerized tomography and magnetic resonance imaging were applied preoperative period. Hydrocephalus was detected in all patients, and external ventricle drainages were applied in our department or in the initial hospitals previously in seven patients before the operation. Patients were followed-up with three months interval with magnetic resonance imaging during the follow-up period. The mean of follow-up duration was 19.3 months (change between 12-72 months). All patients were operated with inferior vermian dissection after suboccipitial craniectomy in concorde position. Results: Postoperative mortality had not occurred. Partial cerebellar excision performed in one patient. Reoperation and ventriculoperitoneal shunt were not required in all patients postoperatively. Conclusion: Although behavior disorders, mutism, and oropharyngeal apraxia were reported in patients who were operated with transvermian approaches, the classic midline approach with inferior vermian dissection was an efficient, controlled, confortable and a simple method for the fourth ventricle tumors.

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