双侧额底纵裂入路切除大型鞍区、鞍后、长人第三脑室肿瘤的临床分析  

Microsurgical removal of large neoplasms located in the suprasellar, back of sellar region and anterior part of third ventricle through bilateral frontobasal interhemispheric approach

作　　者：孙淑文[1] 王增武[2] 王喆[1] 秦时强[1] 魏广鑫[1] 王道奎[1] 宋仁兴[1] 

机构地区：[1]潍坊市人民医院滨海分院神经外科,261000 [2]潍坊市人民医院神经外科,261021

出　　处：《中华神经医学杂志》2014年第12期1260-1263,共4页Chinese Journal of Neuromedicine

摘　　要：目的探讨双侧额底纵裂入路显微切除大型鞍区、鞍后或者长人第三脑室肿瘤的手术策略。方法潍坊市人民医院神经外科自2002年1月至2013年1月应用双侧额底纵裂入路显微切除56例大型鞍区、鞍后或者长人第三脑室肿瘤，回顾性分析患者的临床资料和疗效，总结双侧额底纵裂人路在切除此类肿瘤手术中的优越性及注意事项。结果本组肿瘤全切除49例（88％），次全切除7例（12％）；术中垂体柄保留47例（84％），断裂4例（7％），5例（9％）未见垂体柄；术中嗅神经保护完好50例（89％），单侧损伤6例（11％）；术前视力下降或者视野缺损的41例患者中，术后6个月较术前好转39例，无变化2例；无手术死亡病例，无颅内感染病例；单侧嗅觉丧失2例，额叶轻度水肿2例，3周后水肿消失；脑脊液漏1例，经腰大池引流后2周脑脊液漏停止；尿崩30例，1个月内尿崩消失25例，2～6个月尿崩消失5例；术后1年随访，GOS评分5分（恢复良好）56例（100％），4（7％）例肿瘤大部分切除患者复发再次手术。结论经额底纵裂人路有利于切除大型鞍区、鞍后或者长人第三脑室肿瘤，术野显露充分，便于保留垂体柄、下丘脑、重要穿支动脉、前交通动脉复合体、视神经、视交叉等重要结构，肿瘤全切率高，并发症少，疗效好。Objective To summarize the microsurgical techniques for removal of large neoplasms located in the suprasellar, back of sellar region and anterior part of third ventricle through bilateral frontobasal interhemispheric approach. Methods Fifty-six patients with large neoplasms located in the suprasellar, back of sellar region and anterior part of third ventricle, admitted to our hospital from January 2002 to January 2013 and performed removal via bilateral frontobasal interhemispheric approach; their clinical data and treatment efficacy were analyzed retrospectively. The microsurgical techniques were summarized, and the factors affecting the prognosis were analyzed. Results Total removal of the tumors was achieved in 49 patients （88%） and subtotal removal in 7 （12%）. The pituitary stalk was reserved in 47 patients （84%）, severed in 4 （7%）, and unidentified in 5 （9%）. The bilateral olfactory nerves were successfully preserved in 50 patients （89%） and unilateral severed in 6 （11%）. Visual impairment was found in 41 patients before surgery, 39 of them achieved postoperative visual improvement and 2 patients had no change during the follow-up at 6 months. In our series, there were no procedure-related mortalities and bacterial meningitis. Unilateral anosmia was detected on examination in 2 patients. Minimal frontal lobe contusion developed in 2 patients but resolved within 3 weeks. Cerebrospinal fluid leakage occurred in 1 patient, which was cured for 2 week. Transient diabetus insipidus developed in 25 patients but resolved within 1 month; permanent postoperative diabetesinsipidus was present in 5 patients during the follow-up at 6 months. During the follow-up of 12 months, 56 patients （100%） gained Glasgow outcome scale （GOS） scores of 5, only 4 （7%） patients with tumors resected partially had tumor relapse and received surgery again. Conclusions The bilateral frontobasal interhemispheric approach is appropriate for removing tumors located in the suprasellar, back of sellar regi

关 键 词：脑肿瘤 鞍区 鞍后 第三脑室 显微外科手术 双侧额底纵裂入路 

分 类 号：R739.41[医药卫生—肿瘤]