锁孔入路切除脑室肿瘤  

Keyhole approach for removal of ventricular tumors

作　　者：兰青[1] 朱卿[1] 许亮[1] 陈刚[1] 刘士海[1] 

机构地区：[1]苏州大学附属第二医院神经外科,215004

出　　处：《中华神经外科杂志》2015年第11期1084-1088,共5页Chinese Journal of Neurosurgery

摘　　要：目的探讨锁孔入路手术切除脑室肿瘤的可行性及其技术方法。方法收集2010年1月至2014年12月苏州大学附属第二医院神经外科收治的脑室肿瘤患者共25例，肿瘤平均大小为38．04cm^3，均采用锁孔手术入路进行肿瘤切除。肿瘤位于侧脑室8例，其中经纵裂胼胝体手术1例，经皮质手术7例；第三脑室肿瘤7例，其中经纵裂胼胝体入路4例，经眉弓入路2例，经枕部皮质手术1例；第四脑室肿瘤10例，均经枕下正中入路手术。7例侧脑室肿瘤以及5例第三脑室肿瘤在神经导航下设计手术入路并进行术中导航确认。结果25例脑室肿瘤中，全切除23例，次全切除2例。术前明显脑积水者9例，术后6例脑积水消退，行脑室穿刺外引流及脑室一腹腔引流术各1例，另1例术前行脑室一腹腔引流术。术后肿瘤残腔出血1例，再次手术清除血肿，行去骨瓣减压，出院时神志清楚，伴有不全性失语及肢体偏瘫。其余患者出院时，神志清楚，无肢体活动障碍。结论脑室系统位置深在，适合利用锁孔放大效应对手术野进行充分有效的暴露；通过对脑室系统的脑脊液释放，可有效降低颅内压，增加手术显露空间；术前合并脑积水患者在术后脑脊液循环通畅后，脑积水多可消退，无需常规行脑室一腹腔引流术。Objective To investigate the feasibility and its technical methods of keyhole approach for removal of ventricular tumors. Methods A total of 25 patients with ventricular tumor admitted to the Department of Neurosurgery, the Second Affiliated Hospital of Soochow University from January 2010 to December 2014 were collected. The average tumor size was 38.04 cm^3. All the tumors were resected via the keyhole surgical approach. The tumors of 8 patients were located in the lateral ventricles; one of them was operated via the interhemispheric transcallosal approach and 7 were operated via the cortical approach. Seven patients had the third ventricle tumor, 4 of them were resected via the interhemispheric transcallosal approach, and 2 via the supraorbital approach, and 1 via the occipital cortex. Ten patients with the fourth ventricle tumor were resected via the suboccipital midline approach. The surgical approach in 7 patients with lateral ventricle tumor and 5 with the third ventricle tumor were designed under the neuronavigation and were identified by the intraoperative navigation. Results Of the 25 patients with intraventricular tumor, 23 were totally removed and 2 were subtotally removed. Before procedure, 9 patients had obvious hydrocephalus. The hydrocephalus of 6 cases disappeared after procedure. One patient was performed ventricular puncture drainage and 1 was performed ventficlar-peritoneal drainage, and another one was performed preoperative ventricular-peritoneal drainage. One patient had residual tumor hemorrhage after procedure and was reoperated for hematoma evacuation and decompressive craniectomy. The consciousness of the patient was clear at discharge with partly aphasia and hemiparalysia. No neurologic morbidity was observed when other patients were discharged. Conclusions The position of the ventricular system is deep inside. It is suitable for using keyhole amplification effect to adequately and effectively expose surgical fields. It can effectively decrease intracranial pressure and increase surgic

关 键 词：脑室肿瘤 显微外科手术 锁孔入路 

分 类 号：R739.4[医药卫生—肿瘤]