成人颅咽管瘤术中垂体柄和下丘脑的保护和处理  

Protection and Treatment of the Pituitary Stalk and Hypothalamus in the Microsurgery of Craniopharyngiomas in Adult

作　　者：齐巍[1] 张懋植[1] 张伟[1] 

机构地区：[1]首都医科大学附属北京天坛医院神经外科,北京市100050

出　　处：《中国康复理论与实践》2006年第5期435-437,共3页Chinese Journal of Rehabilitation Theory and Practice

基　　金：北京市科委资助项目(9555101600)。

摘　　要：目的分析和总结成人颅咽管瘤与垂体柄和下丘脑的关系,并在此基础上制定相应的处置方案提高颅咽管瘤根治切除的临床效果。方法66例原发成人鞍上型颅咽管瘤患者采用显微神经外科技术治疗,并对肿瘤与垂体柄和下丘脑的关系及处理进行前瞻性研究。结果36例术中可确认垂体柄存在。颅咽管瘤与垂体柄的关系通常分为无粘连(5例)、粘连(10例)、部分侵润(8例)和完全侵润(13例)。三室底前部受累42例,其中完全消失占10例。手术全切除58例,近全切除8例。术后尿崩症44例,无手术死亡。术后平均随访35月,无肿瘤复发。结论术前选择适当的手术入路,术中仔细辨认和正确处理肿瘤与垂体柄和下丘脑的关系,可有效保护下丘脑垂体系统。Objective To investigate the pattern of the relationship of craniopharyngiomas with pituitary stalks and hypothalamus. Furthermore, based on different patterns affirmed during the operations, surgical strategies were designed for radical excision. Methods A series of 66 patients with primary suprasellar craniopharyngiomas were treated with microsurgical techniques and the relationships of the craniopharyngiomas with pituitary stalk and hypothalamus were analyzed prospectively. Appropriate surgical approaches were selected preoperatively according to the lesion＇s sizes and expanding directions. The relationships of the lesions to the pituitary stalks and hypothalamus were identified in detail and dissected carefully with protection of perforating vessels. Results The patterns that pituitary stalks were involved by craniopharyngiomas were identified in 36 cases and divided into four types; no relation （5 cases）, adhesion （10 cases）, partial invasion （8 cases） and total invasion （13 cases）. The anterior floor of the third ventricle was involved in 42 cases, in which it disappeared totally in 10 eases. Total resection was achieved in 58 case, subtotal resection in 8 cases. Diabetes insipidus （DI） was identified in 44 cases postoperatively. No surgical mortality, no recurrence was found during follow-up of mean 35 months. Conclusion The appropriate selection of surgical approaches preoperatively, careful identification and according treatment of the relationships of the tumors with pituitary stalks and hypothalamus are the keys to protect the pituitary stalk; hypothalamus in craniopharyngiomas resection in adults.

关 键 词：颅咽管瘤 垂体柄 下丘脑 

分 类 号：R651.1[医药卫生—外科学]