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目的 :回顾 7年间 179例手术切除颅咽管瘤的患者 ,总结颅咽管瘤的手术治疗经验。方法 :按与三脑室底的位置关系 ,将肿瘤分为三脑室底上型和三脑室底下型。前者生长于三脑室底上部 ;后者从垂体柄、漏斗、灰结节向上往三脑室底生长阻塞三脑室或向下生长通过鞍膈裂孔进入鞍内。对于三脑室底下型 ,进行翼点入路手术 ,共 15 0例 ,额下入路 16例。对于三脑室底上型采用经胼胝体入路进入三脑室 ,共 13例。在三脑室底下型手术中应特别注意保护进入三脑室底神经结构的穿动脉。三脑室底上型肿瘤经胼胝体入路术中到达三脑室底前部时应避免损伤三脑室底神经结构。结果 :179例手术病例中 ,肿瘤获得全切 16 1例 ,次全切 12例 ,部分切除 6例。垂体柄保留 99例 ,切断 4 6例 ,未发现 34例。所有病人术后随访 3个月到 5年 ,平均 1.5年。随访结果按GOS评分评估。15 4例 (88% )正常生活 ,14例 (8% )生活自理 ,7例 (4 % )生活需要帮助。 7例 (4 % )随访MR发现复发 ,其中 4例为半年内 ,3例为 1年内复发。 5例复发肿瘤再次手术 ,另 2例分别行肿瘤外放疗和伽马刀治疗。结论 :颅咽管瘤切除手术需采用不同的入路以获得最好的显露和最小的肿瘤周围结构损伤。在尝试进行肿瘤全切除时获得好的手术效果的关键是避免损伤下丘脑结构和保?
Objective: To review 179 patients who underwent surgical resection of craniopharyngioma in 7 years and summarize the experience of surgical treatment of craniopharyngioma. Methods: According to the relationship with the base of the third ventricle, the tumor was divided into the third ventricle and the third ventricle. The former grows in the upper part of the third ventricle; the latter from the pituitary stalk, funnel, gray nodules up to the third ventricle growth obstruction of the third ventricle or down through the saddle diaphragm hole into the saddle. For the third ventricle type, pterional approach surgery, a total of 150 cases, the amount of approach 16 cases. For the third ventricle on the type by the corpus callosum into the third ventricle, a total of 13 cases. In the third ventricle type under surgery should pay special attention to protect the bottom of the third ventricle nerve structure of the perforating artery. Third ventricle supratentorial tumors by the corpus callosum surgery to reach the front of the third ventricle should avoid damage to the structure of the third ventricle nerve. Results: Of the 179 surgical cases, 16 1 cases were completely resected, 12 cases were subtotectically resected and 6 cases were partially resected. Pituitary stalk retained 99 cases, 46 cases severed, 34 cases were not found. All patients were followed up for 3 months to 5 years, an average of 1.5 years. Follow-up results were assessed by GOS score. 15 4 (88%) had normal life, 14 (8%) had taken care of themselves and 7 (4%) had to be helped. Recurrence was found in 7 cases (4%) at follow-up, of which 4 were within 6 months and 3 within 1 year. 5 cases of recurrent tumor surgery, the other 2 cases were treated with external tumor radiotherapy and gamma knife treatment. CONCLUSIONS: Craniopharyngioma resections require different approaches to obtain the best possible exposure and minimal tissue damage around the tumor. The key to obtaining a good surgical result when attempting a total tumor resection is to avoid damaging the hypothalamus structure and protecting it.