Removal of tumors of the cerebellum

Special attention during the examination of the posterior cranial fossa should be paid to the position of the cerebellar tonsils. When tumors, cysts or abscess hemispheres M tonsils down and reach arch Atlanta, and sometimes bow II cervical vertebra. The amygdala is on the affected side is lowered below, are often increased, it goes beyond the middle line, partially, and sometimes completely covers the second amygdala. Tumors of the worm Meters, especially the middle and lower divisions, providing uniform pressure on both tonsils, they symmetrically omitted, but with the spread of tumors or cysts worm M predominantly in one of the hemispheres tonsils fall unevenly.
The bark of the cerebellar hemisphere to access tumor cut in any direction, the bark of the worm M - usually longitudinally. Most major blood vessels must be coagulated or clipped. The bark coagulated on the section line and cut through by electrocautery. Pushing white substance spatulas. Spatulas, reaching the cyst wall, should slide on it, not penetrating into, but Uslava capsule from the fabric M. Tumor distinguished from cysts by touch or by color. Find cystic education and opening it cavity, should be very carefully examined the wall cavity all over, because the cyst M usually caused by a tumor, or which adjoins to the wall of the cavity, or protrudes into the cavity. Sometimes the site of the tumor can be detected only by the seal in a certain area of the cyst wall.
At selection of the tumor M. it is necessary to try to work around it within the brain tissue, using a spatula and a tip of a suction pump, systematically koaguliruet and lipirea appropriate to the tumor vessels before cross pH (Fig. 12,7 and 2). Special caution is necessary in areas where the tumor grows wall of the fourth ventricle and approaches diamond-shaped hole. Pulling up this site of the tumor can cause bleeding in the medulla.
When a large tumor of the cerebellum (especially worm M) with venous stagnation in the posterior cranial fossa try at once to highlight the tumor is often accompanied by a large bleeding and significant brain injury. In some cases it is advisable to first reduce the amount of tumor, removing the Central parts of the brain stomach (Fig. 12,3) or asthmatics. Then allocate the peripheral parts of tumor and delete it all. If tumor spreads to the trunk or its fusion with the bottom IV heart sometimes limited to partial removal of the tumor. At partial tumor removal of the fourth ventricle, the most important to remove the upper pole of the site, plugging the water supply of the brain; it is restored outflow of cerebrospinal fluid from the ventricular system and eliminated occlusive hydrocephalus.
When you select arachnodactyly cerebellum follow basically the same technique as in the destruction of these tumors on the convex surface of the big hemispheres (see brain).
When cystic cavities nonneoplastic etiology operation is limited by dissection M, wide opening and emptying the cavity of the cyst excision its capsule.
Identifying occlusion caused by adhesions in the area median holes of the fourth ventricle, try to disconnect spike, either longitudinally cut worm M with the opening of the fourth ventricle; then restored the circulation of cerebrospinal fluid.
In partial removal of the tumor stitching Dura dramatically reduces decompressive effect, and improving usually lasts not for years and months. Sew Dura valid if the disease process is not accompanied by increased vnutricerepnogo pressure, and when there is no apparent swelling of the cerebellum, for example, when a benign tumor of the cerebellum completely removed, and in the postoperative period it is unlikely to cause it apparent swelling.
Layer-by-layer stitches to create a powerful wall of soft tissues is one of the crucial stages of the operation, preventing formation of liquor fistula (see Liquore) and bulging.