显微神经外科手术治疗41例复发颅咽管瘤  

Microneurosurgery treatment for 41 recurrent craniopharyngioma cases

作　　者：向鑫 石祥恩[1] 雷霆 胡孟庆 冉春雷 刘方军[1] Xiang Xin;Shi Xiang′en;Lei Ting;Hu Mengqing;Ran Chunlei;Liu Fangjun(Department of Neurosurgery,Capital Medical University Sanbo Brain Hospital,Beijing100093,China)

机构地区：[1]首都医科大学三博脑科医院神经外科,北京100093

出　　处：《中国医师进修杂志》2022年第10期873-876,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨显微神经外科手术治疗复发颅咽管瘤的方法及疗效。方法回顾性分析2018年1月至2022年1月首都医科大学三博脑科医院显微神经外科手术治疗的41例复发颅咽管瘤患者的临床资料,并观察患者的疗效。结果41例患者中,38例采用额底纵裂入路,3例采用纵裂联合侧裂入路。肿瘤全切34例(82.9%),次全切7例(17.1%)。围手术期因肺栓塞死亡1例(2.4%)。其余所有患者术后均出现一过性电解质紊乱,经治疗后,3个月内恢复正常。均出现内分泌功能障碍,激素替代治疗3个月后,11例后续不需要激素替代治疗。术后3例出现视力较术前下降,2例治疗后好转。结论手术治疗复发颅咽管瘤难度很大,对医生及患者都是巨大的挑战。然而经过对患者个体化的评估和手术中医生精细化的操作,可以使复发颅咽管瘤术后达到一个满意的疗效。Objective To investigate the method and effect of microneurosurgery in the treatment of recurrent craniopharyngioma.Methods The clinical data of 41 recurrent craniopharyngioma patients treated by microneurosurgery in Capital Medical University Sanbo Brain Hospitalfrom January 2018 to January 2022 were retrospectively analyzed.Results Among the 41 patients,38 cases were treated with the frontal basal interhemispheric approach and 3 cases with the translongitudinal fissure combined with the transSylvian fissure approach.Gross total resection was performed in 34 cases(82.9%)and subtotal resection in 7 cases(17.1%).One patient(2.4%)died of pulmonary embolism during perioperative period.All patients had transient electrolyte disorder after operation,and recovered within 3 months after treatment.All patients had endocrine dysfunction.After 3 months of hormone replacement therapy,11 patients were cured.Visual acuity decreased in 3 cases after operation,and 2 cases improved after treatment.Conclusions Surgical treatment of recurrent craniopharyngioma is very difficult,which is a great challenge for doctors and patients.However,through the individualized evaluation of the patients and the meticulous technique of the doctors during the operation,a satisfactory effect can be achieved post the operation of recurrent craniopharyngioma.

关 键 词：颅咽管瘤 神经外科手术 鞍区 额底纵裂入路 纵裂联合侧裂入路 

分 类 号：R739.41[医药卫生—肿瘤]