前纵裂入路显微手术切除鞍区颅咽管瘤  

Clinical effectiveness of microsurgery via anterior interhemispheric approach for craniopharyngiomas

作　　者：徐海涛[1] 黄书岚[1] 陈谦学[1] 陈治标[1] 葛剑[2] 许州[1] 朱晓楠[1] 王龙[1] 

机构地区：[1]武汉大学人民医院神经外科,武汉430060 [2]武警湖北省总队医院神经外科,武汉430061

出　　处：《中国临床神经外科杂志》2013年第11期651-653,共3页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨前纵裂入路显微手术切除鞍区颅咽管瘤的疗效。方法回顾性分析19例经前纵裂入路手术治疗的颅咽管瘤病人的临床资料。结果肿瘤全切除14例,大部分切除4例,1例因肿瘤大片钙化并粘连严重仅行部分切除。术中保留垂体柄12例,被肿瘤完全侵蚀的垂体柄切除4例,未见垂体柄或垂体3例。术后视力改善11例、恶化1例。术后1例出现额叶血肿行血肿清除术;1例术后16 d死于重度肺部感染。术后16例出现尿崩、电解质紊乱,14例出现垂体功能障碍,均给予对症治疗。15例术后随访3~36个月,肿瘤复发2例。结论对于以中线生长为主、无明显偏侧生长的大型和巨大型鞍区颅咽管瘤,前纵裂入路可获得良好的术野暴露,手术安全、效果良好。ObjectiveTo explore the clinical effectiveness of microsurgery via anterior interhemispheric approach for large or giant craniopharyngiomas located in the sellar region.MethodsThe clinical data of 19 patients with large or giant craniopharyngioma who underwent microsurgery via anterior interhemispheric approach from March 2008 to September 2012 were analyzed retrospectively. ResultsThe maximum tumor diameter ranged from 3.5 cm to 6.5 cm. According to Samii＇s classification system for craniopharyngiomas, 4, 8 and 7 patients were belonged to gradeⅡ,ⅢandⅣ, respectively. Total resection was achieved in 14 patients, subtotal in 4 and partial in 1 due to widespread calcification and severe adhesion. The pituitary stalk was reserved in 12 patients and resected in 4 due to complete erosion by tumors, and no pituitary stalk or pituitary was found in 3 patients. Visual acuity improved in 11 patients and worsened in 1 after operation. Postoperative diabetes insipidus occurred in 16 patients, of whom, 13 recovered after treatment and 3 had to take desmopressin acetate to control their urinary production. Endocrine disorders occurred in 14 patients who had to receive hormone replacement therapy. One patient died of severe pulmonary infection 16 days after operation. Fifteen patients were followed up for 3~36 months; 2 patients recurred.ConclusionThe microsurgery via anterior interhemispheric approach is a feasible and effective treatment method for large or giant craniopharyngiomas located in the sellar region.

关 键 词：颅咽管瘤 前纵裂入路 显微手术 

分 类 号：R739.41[医药卫生—肿瘤] R651.11[医药卫生—临床医学]