不同手术入路切除颞叶内侧胶质瘤的手术效果  

Surgical outcomes of different approaches for mesial temporal lobe gliomas

作　　者：姜中利[1] 王忠诚[1] 江涛[1] 

机构地区：[1]首都医科大学附属北京天坛医院神经外科,100050

出　　处：《中华医学杂志》2005年第34期2428-2432,共5页National Medical Journal of China

摘　　要：目的探讨不同手术入路切除颞叶内侧胶质瘤的手术效果。方法对采用不同手术入路治疗的62例颞叶内侧胶质瘤患者的手术效果进行了分析。62例中肿瘤限局于颞叶内侧结构(A型)33例,其中位于颞叶内侧前部(A1型)19例,病变向颞叶内侧后部生长(A2型)14例;肿瘤广泛侵袭颞叶内侧、岛叶和额眶回后部(B型)9例;肿瘤向颞极和侧脑室颞角外侧侵袭(C型)14例;肿瘤向内侧侵袭脑干、基底节和丘脑(D型)6例。手术入路的选择有3种:经外侧裂入路、经颞叶入路及颞下入路。结果经外侧裂入路25例次,肿瘤全切除14例,近全切除6例,大部切除5例,术后原视觉障碍加重2例。经颞叶入路23例次,肿瘤全切除15例,近全切除5例,大部切除3例,术后原视觉障碍加重5例,新发生视觉障碍4例。颞下入路14例次,肿瘤全切除10例,近全切除4例,术后无发生视觉障碍病例。结论经外侧裂和颞下入路能减少对脑组织和视放射的损伤,而侧方经颞上回、中回入路可能损伤脑组织和视放射。Objective To analyze the surgical outcomes of different approaches for mesial temporal lobe gliomas . Methods Microsurgery was performed via transsylvian, transtemporal, or subtemporal approaches on 62 patients with mesial temporal lobe gliomas, 33 with localized tumors within the mesial temporal structures （type A） , 19 in anterior portion （type A1 ）, and 14 extending to posterior portion （type A2）; 19 patients with muhicompartmental tumors involving the mesial temporal lobe, insular lobe, and posterior frontoorbital gurus （type B ） ; 14 patients with tumors involving the temporal pole and lateral areas of the temporal horn （ type C ） ; and 6 patients with tumors infiltrating the brain stem, basal nuclei and thalamus （ type D）. Results Transsylvian approach was performed in 25 cases of which total tumor removal was achieved in 14 cases, subtotal removal in 6 cases, and gross removal in 5 cases. Primary visual deficits worsened after surgery in 5 cases. Transtemporal approach was used in 23 cases of which total tumor resection was achieved in 15 cases, subtotal resection in 5 cases, and gross resection in 3 cases. Primary visual deficits worsened after surgery in 5 cases. Four patients in which preoperative vision were good presented with visual deficits postoperatively. Subtemporal approach was used in 14 cases of which total tumor removal was achieved in 10 cases, and subtotal removal in 4 cases. All 14 patients did not develop worsened vision after surgery. Conclusion Transsylvian and subtemporal approaches can reduce possible harm to parenchyma and optic radiation, whereas approaches to the temporal horn through the superior and middle temporal gyri will induce damage to parenchyma and optic radiation.

关 键 词：颞叶内侧 胶质瘤 手术入路 肿瘤全切除 内侧结构 手术效果 颞叶 经外侧裂入路 视觉障碍 颞下入路 

分 类 号：R739.41[医药卫生—肿瘤]