Evaluation of transcerebellomedullary fissure approach and its clinical application

Objective To explore different types of trans-CMF approaches in removing the lesions located in the cerebellomedullary fissure(CMF),pons and the fourth ventricle,and evaluate the clinical outcome of their application.Methods The different types of trans-CMF approach(extensive type,lateral wall type,lateral recess type)were adopt in removing the lesions located in the CMF、fourth ventricle、dorsolateral to the pons and medulla in 20 patients.The degree of resection and the sufficiency of exposure were compared during the operation.In addition,the short-term prognosis and the complication related to the operation were also evaluated.Results The lesions were removed by extensive type(11cases),lateral wall type(7cases)and lateral recess type(2cases).Sufficient exposure of the lesions were achieved in 16cases,less sufficient in 2cases and exposing with difficulty in 2cases.Complete excision were achieved in 10cases,sub-total removal in 6 cases and partial removal in 4cases.GOSs of the patients at discharge are 5 points in 12cases and 4 points in 8cases.Conclusions Extensive type of trans-CMF approach provides sufficient exposure for removing lesions of the area from the aqueduct to obex,while lateral wall type and lateral recess type of trans-CMP approaches are more appropriate in removing the lesions of the lateral recess,middle cerebellar peduncle and dorsolateral part of the pons and medulla.