神经内镜下经幕下小脑上入路切除松果体区肿瘤四例临床分析  

Pineal gland tumor resection via supracerebellar infratentorial approach under neuroendoscope:a clinical analysis of four cases

作　　者：朱剑栋 续岭 肖顺武 谢明祥 Zhu Jiandong;Xyu Ling;Xiao Shunwu;Xie Mingxiang(Department of Neurosurgery,Affiliated Hospital of Zunyi Medical University,Zunyi 563000,China)

机构地区：[1]遵义医科大学附属医院神经外科,遵义563000

出　　处：《中华神经医学杂志》2020年第4期391-395,共5页Chinese Journal of Neuromedicine

基　　金：贵州省科技计划项目(黔科合成果[2019]4438号)。

摘　　要：目的探讨神经内镜下经正中和旁正中幕下小脑上入路切除松果体区肿瘤的临床效果。方法回顾性分析自2017年12月至2019年3月遵义医科大学附属医院神经外科同一术者开展的神经内镜下经幕下小脑上入路切除松果体区肿瘤4例患者的临床资料,患者术前均行头颅MRI平扫+增强扫描,术中采用侧俯卧位全麻下神经内镜下经幕下小脑上入路(旁正中入路3例、正中入路1例)切除肿瘤,术后随访3~12个月并行头颅MRI复查。结果4例患者的肿瘤均完全切除。2例术后病理证实为混合性生殖细胞肿瘤,1例为精原细胞瘤,1例为成熟性畸胎瘤。1例术后恢复良好;2例给予全脑全脊髓放疗,其中1例4个月后原病灶处复发,给予全身化疗,至今未复发,另一例恢复良好;1例因经济原因未行放化疗,术后4个月复发。结论神经内镜经正中及旁正中幕下小脑上入路切除松果体区肿瘤创伤小、并发症少、安全有效,术前需根据肿瘤的血供情况、大小、部位等选择最佳的手术入路。Objective To investigate the clinical effacies of endoscopic midline and paramedian supracerebellar infratentorial(SCIT)approaches during resection of pineal tumors.Methods The clinical data of 4 patients with pineal tumors resected via SCIT approach under neuroendoscope in our hospital from December 2017 to March 2019 were analyzed retrospectively.All patients underwent MR imaging plain and enhanced scans before operation.The tumors were resected via SCIT approach under general anesthesia in lateral subduction position(three were via paramedian SCIT approach and one was via midline SCIT approach).The patients were followed up for 3-12 months and the brain MR imaging was reexamined.Results The tumors were completely resected in 4 patients.Two patients were confirmed to have mixed germ cell tumors,one was confirmed to have seminoma,and the other one was confirmed to have mature teratoma by postoperative pathology.One achieved good recovery after surgery.Two were treated with whole brain and spinal cord radiotherapy,the original lesion in one patient recurred 4 months after resection and systemic chemotherapy was given,and so far,no recurrence was noted;and the other one achieved good recovery.One did not receive chemoradiotherapy due to economic reasons and relapsed 4 months after surgery.Conclusion It is safe and effective to resect the tumors in pineal region via midline and paramedian SCIT approaches with neuroendoscopy;the best approach should be selected according to the blood supply,size and location of the lesions.

关 键 词：松果体区 颅内肿瘤 神经内镜 经幕下小脑上入路 

分 类 号：R73[医药卫生—肿瘤]