经纵裂-胼胝体-脉络膜裂入路显微手术治疗159例松果体区病变的效果分析  

Clinical effect of microsurgery via the anterior interhemispheric-transcallosal-choroi⁃dal approach in treatment of pineal region lesions:A analysis of 159 cases

作　　者：刘化飞 肖格磊[2,3] 李健 廖新斌[2,3] 刘景平[2,3] 张治平[2,3] LIU Huafei;XIAO Gelei;LI Jian;LIAO Xinbin;LIU Jingping;ZHANG Zhiping(The First People's Hospital of Shaoyang City,Shaoyang,Hunan 422000,China;Department of Neurology,Xiangya Hospital Central South University,Changsha,Hunan 410008,China;Diagnosis and Treatment Center for Hydrocephalus,Xiangya Hospital Central South University,Changsha,Hunan 410008,China)

机构地区：[1]邵阳学院附属第一医院,湖南邵阳422000 [2]中南大学湘雅医院神经外科,湖南长沙410008 [3]中南大学湘雅医院脑积水诊疗中心,湖南长沙410008

出　　处：《国际神经病学神经外科学杂志》2023年第1期21-24,共4页Journal of International Neurology and Neurosurgery

基　　金：国家自然科学基金面上项目(82171347);湖南省自然基金委员会资助项目(2022JJ30971)。

摘　　要：目的探讨经纵裂-胼胝体-脉络膜裂入路显微手术切除松果体区病变的可行性、疗效及优缺点。方法分析湘雅医院神经外科2010年7月—2018年12月收治的159例经纵裂-胼胝体-脉络膜裂入路行显微手术治疗松果体区病变患者的资料,统计患者一般情况、主要症状、病变切除程度、病变病理性质、术后并发症、术后生存时间等情况,分析患者的疗效。结果159例患者中,143例病变得到全切,10例次全切,6例大部分切除。2例患者围手术期间分别因丘脑下部损伤、呼吸循环衰竭死亡。2例患者术后出现硬膜外血肿,清除血肿后缓解。4例患者出现慢性硬膜下积液,行钻孔引流术后无效,行硬膜下积液腹腔分流后缓解。16例患者术后出现脑积水,2例行内镜下三脑室底造瘘后缓解,14例行脑室腹腔分流术后缓解。患者随访6个月~9年,5年生存率81.3%。结论患者总体疗效较好,经纵裂-胼胝体-脉络膜裂入路是一种安全有效切除松果体区肿瘤的手术路径。Objective To investigate the efficacy,safety,advantages,and disadvantages of microsurgery via the anterior interhemispheric-transcallosal-choroidal approach in resecting pineal region lesions.Methods An analysis was performed for the clinical data of 159 patients with pineal region lesions who were admitted to Department of Neurosurgery,Xiangya Hospital,from July 2010 to December 2018 and underwent microsurgery via the anterior interhemispherictranscallosal choroidal approach,including general status,main symptoms,extent of resection,pathological nature of lesion,postoperative complications,and postoperative survival time.Results Of all 159 patients,143 achieved total resection of lesions,10 had subtotal resection of lesions,and 6 had massive resection of lesions.Two patients died of subthalamic injury and respiratory failure,respectively,during the perioperative period.Two patients developed extradural hematoma after surgery,which was relieved after hematoma clearance.Four patients had chronic subdural effusion,which had no response to borehole drainage and was relieved after intraperitoneal shunt of subdural effusion.There were 16 patients who developed hydrocephalus after surgery,among whom 2 patients were relieved after endoscopic third ventriculostomy and 14 were relieved after ventriculoperitoneal shunt.The patients were followed up for 6 months to 9 years,with a 5year survival rate of 81.3%.Conclusions Patients tend to have a good outcome after surgery,and the anterior interhemispheric-transcallosal-choroidal approach is a safety and effective surgical approach for pineal region lesions.

关 键 词：脑肿瘤 中线肿瘤 松果体区 经纵裂-胼胝体-脉络膜裂入路 全切除 

分 类 号：R739.41[医药卫生—肿瘤]