改良Poppen入路显微手术切除松果体区肿瘤30例临床体会  

Clinical experience of microsurgery in resection of 30 cases of pineal region tumors through the modified Poppen approach

作　　者：霍峻峰[1] 陈小兵[1] 刘献志[2] 翟广[2] 

机构地区：[1]河南大学淮河医院神经外科,开封475000 [2]郑州大学第一附属医院神经外科

出　　处：《中国实用医刊》2013年第24期60-61,共2页Chinese Journal of Practical Medicine

摘　　要：目的 探讨改良Poppen入路显微手术切除松果体区肿瘤的经验.方法 经改良Poppen入路松果体区肿瘤切除患者30例,归纳和总结术中重要的静脉间隙解剖结构和手术操作要点.结果 肿瘤全切28例,次全切2例.病理结果证实恶性肿瘤22例,良性肿瘤8例.术后并发脑积水加重4例,颅内血肿3例,同向偏盲2例,高热昏迷死亡1例.随访29例,随访时间为2个月～6年,其中Bathel指数评定：生活需要较大帮助（20～40分）2例,生活基本自理（40分～60分）9例,生活完全自理（＞60分）18例.结论 采用改良Poppen入路显微手术切除松果体区肿瘤效果良好,术中小脑幕切迹后间隙的静脉复合体为松果体区,为手术操作的主要阻碍,通过适合的静脉间隙进行显微操作能够完整、安全的将肿瘤切除.第三脑室后壁的打通可能对术后脑积水的改善具有积极作用.Objective To investigate the experience of microsurgical anatomy in resection of the pineal region tumors through the modified poppen approach.Methods The clinical data of 30 patients with tumor in the pineal region resected by microsurgery through modified Poppen approach were analyzed retrospectively,and the key anatomic gaps between the veins in the region and the key operation points in the surgical procedure were summarized.Results The total tumor removal was achieved in 28 cases,subtotal removal in 2 cases.The tumors were benign in 22 patients and malignant in 8 cases,which were confirmed by biopsy.Hydrocephalus aggravated in 4 cases,and intracranial hematoma occurred in 3 cases,and homonymous hemianopia presented in 3 cases,and one died of high temperature and coma.Twentynine patients were followed up for 2 month to 6 years.According to Bathel index,18 cases acquired scores above 60,9 cases acquired scores between 40 and 60,and 2 cases acquired scores between 20 and 40.Conclusions The effect of microsurgery in resection of the tumor in the pineal region through modified Poppen approach is good.Veins complex in the posterior gap of tentorial notch is the main barrier in the surgical procedure,but the rumor can be resected totally and safely through proper vein gap.Intraoperative fistulization on the posterior wall of the third ventricule may play an active role in improving postoperative hydrocephalus.

关 键 词：松果体区 POPPEN入路 静脉间隙 第三脑室后壁 

分 类 号：R739.4[医药卫生—肿瘤]