经纵裂-胼胝体-穹窿间入路显微手术治疗儿童中脑海绵状血管瘤  

Surgery via transcallosal anterior interforniceal approach for midbrain cavernous malformations in children(report of 7 cases)

作　　者：刘巍[1] 宫剑[1] 马振宇[1] 李春德[1] 

机构地区：[1]首都医科大学附属北京天坛医院神经外科,北京100050

出　　处：《中国临床神经外科杂志》2016年第2期65-68,共4页Chinese Journal of Clinical Neurosurgery

摘　　要：目的 探讨经纵裂-胼胝体-穹窿间入路显微手术治疗儿童中脑海绵状血管瘤的效果。方法 回顾性分析2000-2013年收治的7例儿童中脑海绵状血管瘤的临床资料,全部病例均应用经前纵裂-胼胝体-穹窿间入路手术治疗。结果 7例患儿的病灶均全切除,无术后意识障碍和手术死亡病例,术后病理证实均为海绵状血管瘤,其中1例合并静脉畸形。所有病例均随访13-152个月,平均51.3月;无死亡病例,无复发再出血;4例脑积水未缓解者行脑室-腹腔分流术,其中1例随访期间成功拔除分流管;5例术后早期有短暂记忆力下降,4例于3-6个月后恢复正常;3例患儿术后出现双眼上视不全,1例随访期间恢复正常,2例部分恢复;1例患儿术前存在动眼神经麻痹,随访发现眼睑下垂有好转。结论 经前纵裂-胼胝体-穹窿间入路手术是治疗中脑海绵状血管瘤的安全有效的方法,尤其适合切除病灶位于中脑腹侧和突入第三脑室内的病灶。该手术方法暴露病灶清晰,便于显露并保护大脑深部静脉和直视下切除病灶,全切率高,预后满意。Objective To explore the technique of microsurgery via transcallosal anterior interforniceal （TAIF） approach for midbrain cavernous malformations （CMs） and its effects on CMs in children. Methods The clinical data of 7 children with CMs, which were resected by microsurgery, were analyzed retrospectively, including surgical outcomes, following up data and so on. Results CMs were totally removed in all the children. No children died and no intracranial rehemorrhage or conscious disturbance occurred in all the children. All the patients were followed up for 51.3 months. The hydrocephalus which occurred after the surgery in 4 children was treated by ventriculoperitoneal shunt during the following-up. Short-term memory which was lost after the surgery returned to normal from 3 to 5months after the surgery in 5 children. Of 3 children who had Parinaud＇s syndrome after the surgery; 2 were perfectly recovered and 1 partly. The drooping eyelid disappeared gradually during the following-up in 1 child with oculomotor nerve paresis. Conclusions The midcrosurgery via TAW approach which is a safe and effective method to treat midbrain CMs in children, is very helpful to total resection of CMs, especially those which are in the ventral midbrain and intrude into third ventricle, because it is of the merits such as clear operative field and few postoperative complications.

关 键 词：海绵状血管瘤 中脑 儿童 显微手术 经前纵裂-胼胝体-穹窿间入路 疗效 

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