摘要 目的：根据后颅窝肿瘤不同部位选择最佳手术入路。后颅窝开颅术改咬骨窗为开骨瓣。方法：蚓部肿瘤选择后颅窝正中入路。小脑半球肿瘤行正中钩形切口，肿瘤偏外选择外侧钩形切口。上蚓部肿瘤选择Poppen入路。三种骨瓣：正中骨瓣、单侧骨瓣、单侧跨中线骨瓣。术毕骨瓣复位。结果：实施38例儿童后颅窝肿瘤全切除术，髓母细胞瘤23例，星形细胞瘤10例，室管膜瘤3例，血管母细胞瘤1例，脑脓肿1例。无皮下积液发生，3例术后10天内发烧。结论：后颅窝开骨瓣术、硬膜缝合、骨瓣复位符合解剖复位原则，术后并发症少，避免了因颅骨缺损造成的对儿童心理发育的不良影响。

Abstract Objective: By using of suboccipital craniotomy for removal of theposterior fossa tumors in order to maintain anatomical replacement. Operative approacheswere chose according to the locations of the tumors. Methods: Four approaches can be chosefor the posterior were selected. Suboccipital medial approach, suboccipital middle hookedapproach, suboccipital lateral hooked approach, and occipital transtentorial approach.There were three kinds of bone flaps: median, unilateral, and unilateral-median. Themedian bone flap was used for the vermis medulloblastomas, the unilateral flap for thecerebellar tumors and the unilateral-median flap for the cerebellar tumors that extendedbeyond the vermis. At the procedure, the upper border and the lateral border of the boneflap were cut by Gigli saw or cranitome, the lower line was opened to the foramen magnumby rongeur. Results: There were 38 patients with medulloblastomas in 23, astrocytomas in10, ependymomas in 3, hemangioblastoma in 1, and brain abscess in 1. All cases underwentthe craniotomy and the tumors were removed totally under the microscope. There were nopostoperative complications. Conclusions: The advantages of suboccipital craniotmy areanatomical replacement, less postoperative complications caused by suboccipital craniectomy, and beneficial to children's mental health.

     ......