神经内镜在脑室内肿瘤术中的应用  

Application of neuroendoscope in intraventricular tumor surgery

作　　者：毛贝贝[1] 胡志强[1] 黄辉[1] 关峰[1] 戴缤[1] 肖智勇[1] 朱广通[1] 

机构地区：[1]首都医科大学附属北京世纪坛医院神经外科,100038

出　　处：《中华神经外科杂志》2015年第7期658-662,共5页Chinese Journal of Neurosurgery

摘　　要：目的探讨神经内镜治疗脑室内肿瘤的手术技术及疗效。方法回顾性分析2005年7月至2013年2月首都医科大学附属北京世纪坛医院神经外科应用神经内镜治疗的脑室内肿瘤患者的临床资料及手术效果，共15例。侧脑室肿瘤7例，第三脑室肿瘤7例，脑室内多发肿瘤1例。均于导航指引下手术，术后常规随访，并进行Karnofsky评分（KPS）。结果15例中，单纯神经内镜下活检5例，肿瘤全切除3例，近全切1例；神经内镜结合显微镜全切除肿瘤3例，近全切除3例。合并脑积水10例，其中9例行第三脑室底造瘘术，2例同时行透明隔造瘘术。术后6例行化疗，3例行放射治疗。术后随访2～36个月，平均15．8个月。KPS〉80分12例，60～80分2例，0分（死亡）1例。结论神经内镜手术治疗脑室内肿瘤既可通过活检明确肿瘤的病理学性质，又可根据肿瘤的大小及性质选择单纯神经内镜切除，或神经内镜结合显微镜切除。Objective To investigate the surgical techniques for neuroendoscopic treatment of intraventricular tumors. Methods The clinical data and surgical efficacy of 15 patients with intraventricular tumor treated with neuroendoscope at the Department of Neurosurgery, Beijing Shijitan Hospital, Capital Medical University from July 2005 to February 2013 were analyzed retrospectively. Seven patients had lateral ventricle tumors, 7 had the third ventricle tumors, and 1 had intraventricular multiple tumor. The patients were operated under the guidance of navigation. They were followed up routinely after procedure and were assessed by the Karnofsky scores. Results Of the 15 patients, 5 took a biopsy under the neuroendoscope and 3 had a total tumor removal, and 1 had a subtotal resection; 3 had a total tumor removal under a neuroendoscope and a microscope, and 3 had near total resection. Of the 10 tumor patients with hydrocephalus, 9 underwent endoscopic third ventriculostomy and 2 underwent pellucid septostomy simultaneously. The intracranial hypertension symptoms were relieved significantly after procedure. Six patients received chemotherapy and 3 received radiotherapy after procedure. They were followed up for 2 to 36 months （mean 15.8 months） after procedure. The Karnofsky score was 〉 80 in 12 eases, 60 to 80 in 2, and 0 （died） in 1. Conclusions The surgical treatment of intraventricular tumors with a neuroendoscope is safe and effective. It can not only clearly identify the pathological nature through biopsy, but also choose a tumor resection alone or tumor resection with a microscope according to the size and nature of tumors.

关 键 词：神经内窥镜 脑室内肿瘤 

分 类 号：R739.41[医药卫生—肿瘤]