脑室内肿瘤合并脑积水的神经内镜治疗  

Neuroendoscopic treatment of intraventricular tumor complicated by hydrocephalus

作　　者：毛贝贝[1,2] 胡志强[1] 黄辉[1] 戴缤[1] 关峰[1] 朱广通[1] 王劭恒[1,2] 任乐宁[1,2] 康庄[1,2] 

机构地区：[1]首都医科大学附属北京世纪坛医院神经外科,实习医生100038 [2]哈尔滨医科大学,150001

出　　处：《中国微侵袭神经外科杂志》2011年第7期310-313,共4页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：北京世纪坛医院科研基金(编号:2008-16;2009-23)

摘　　要：目的探讨神经内镜手术治疗脑室内肿瘤合并脑积水的方法与技巧。方法回顾性分析10例脑室内肿瘤合并脑积水的临床资料,其中肿瘤位于侧脑室5例,第三脑室4例,脑室内多发肿瘤1例。均在神经导航指引下行内镜手术,同时行第三脑室造瘘术9例,透明隔造瘘术1例。结果肿瘤全切除8例,次全切除1例,仅行活检1例。术后颅高压症状均缓解,发现不同程度发热3例,无癫间疒发作及其他严重并发症。术后脑脊液磁共振电影成像(Cine MRI)显示所有病人脑脊液循环动力学均不同程度改善。随访3～24个月,平均10.6个月,死亡1例,无肿瘤复发;复查MRI显示脑室体积轻度缩小2例,无明显变化8例。结论神经内镜手术既可切除肿瘤,又能重建脑脊液循环,可作为脑室内肿瘤合并脑积水的首选治疗方法。应根据脑室形态和肿瘤位置、大小、性质等在导航引导下选择个体化的手术入路切除肿瘤。Objective To investigate the surgical methods and techniques of neuroendoscopic treatment for intraventricular tumor with hydrocephalus.Methods Clinical data of 10 patients with intraventricular tumor companied with hydrocephalus were analyzed retrospectively.The tumors seated in lateral cerebral ventricles in 5 cases,third ventricle in 4 and intraventricular multiple tumors in 1.The endoscopic surgery guided by neuronavigation was performed in all the patients,including endoscopic third ventriculostomy in 9 cases and septum pellucidum ventriculostomy in 1.Results Total tumor resection was achieved in 8 cases,subtotal resection in 1 and biopsy in 1.The symptoms of high intracranial pressure were improved postoperatively in all the patients,but there were different degrees of fever in 3.No epileptic seizure and other serious complications occurred postoperatively.Postoperative Cine MRI showed that dynamics of cerebrospinal fluid circulation improved to different extents in all patients.During a follow-up period of 10.6 months,ranged from 3 to 24 months,there was one patient died and no tumors recurred.MRI reexamination showed the volume of cerebral ventricle reduced lightly in 2 cases and was not obviously changed in 8.Conclusions The neuroendoscopic surgery can not only resect the tumors,but also restore and rebuild the cerebrospinal fluid circulation,thus being the first choice for treatment of ventricular tumor with hydrocephalus.In addition,the appropriate surgical approach should be based on the ventricle shape,tumor location,size,and characteristics.

关 键 词：脑室肿瘤 脑积水 神经内镜 

分 类 号：R739.41[医药卫生—肿瘤] R742.7[医药卫生—临床医学]