64例松果体区肿瘤神经内镜治疗效果观察  

Results of neuroendoscopy for pineal region tumors in 64 cases

作　　者：李明 李召兵 张衍 Juha Antero HERNESNIEMI 陈中灿 胡森 段林 LI Ming;LI Zhaobing;ZHANG Yan;Juha Antero HERNESNIEMI;CHEN Zhongcan;HU Sen;DUAN Lin(Department of Neurosurgery,Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Zhengzhou,Henan 450003,China;Department of Medical Records,Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Zhengzhou,Henan 450003,China;Department of Juha Hernesniemi International Center for Neurosurgery,Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Zhengzhou,Henan 450003,China)

机构地区：[1]河南省人民医院,郑州大学人民医院神经外科,河南郑州450003 [2]河南省人民医院,郑州大学人民医院病案管理科,河南郑州450003 [3]河南省人民医院,郑州大学人民医院Juha Hernesniemi国际神经外科中心,河南郑州450003

出　　处：《中华实用诊断与治疗杂志》2023年第9期926-929,共4页Journal of Chinese Practical Diagnosis and Therapy

摘　　要：目的观察松果体区肿瘤患者行神经内镜手术治疗的效果,探讨其安全性。方法回顾性分析2009年4月—2020年10月河南省人民医院接受神经内镜手术治疗的64例松果体区肿瘤患者临床资料。结果64例中经幕下小脑上入路(Krause入路)21例,经枕下幕上入路(Poppen入路)36例,经额皮质入路6例,经三角区侧脑室入路1例,手术均顺利完成,手术时间(6.15±2.26)h,术中出血量(373.44±63.82)mL,住院时间(24.08±11.25)d。术后1~2 d行头颅MRI/CT检查,病灶全部切除55例(86%),次全切除9例(14%)。术后均未发生脑室积血、脑积水、硬脑膜外血肿、视野缺损、颅内感染等并发症,出现视物模糊或同向偏盲7例、耳部麻木2例,给予康复理疗未完全康复;3例出现无感染的脑脊液漏,经保守治疗康复。术后组织病理检查结果证实恶性肿瘤17例,其中生殖细胞瘤11例,松果体母细胞瘤2例,低级别胶质瘤3例,肺癌脑转移1例;良性肿瘤47例,其中脑膜瘤20例,蛛网膜囊肿12例,松果体实质瘤5例,胆脂瘤5例,淋巴瘤3例,血管畸形2例。恶性肿瘤17例中4例术后行伽玛刀治疗,7例行放疗,4例行化疗,2例行放疗+化疗。术后随访至2021年2月,14例失访,37例无症状生存,13例术前症状得到改善。结论松果体区肿瘤组织病理类型复杂,神经内镜手术治疗效果满意、安全性好,恶性松果体区肿瘤患者术后联合放化疗可改善预后。Objective To observe the outcome of neuroendoscopy in the treatment of pineal region tumors,and to investigate its safety.Methods The clinical data of 64 patients with pineal region tumors who underwent neuroendoscopic surgery from April 2009 to October 2020 in Henan Provincial People's Hospital were retrospectively analyzed.Results Among 64 cases,the operation was performed via infratentorial supracerebellar approach(Krause approach)in 21 cases,via transoccipital supratentorial approach(Poppen approach)in 36 cases,via transfrontal cortical approach in 6 cases,and via transtriangular lateral ventricular approach in 1 case.All operations were successfully completed.The operation lasted for(6.15±2.26)h,the intraoperative blood loss was(373.44±63.82)mL,and the length of hospital stay was(24.08±11.25)d.Head MRI/CT examination 1-2 days after operation showed that total resection of the lesions was achieved in 55 cases(86%)and subtotal resection in 9 cases(14%).No complications such as intraventricular hemorrhage,hydrocephalus,epidural hematoma,visual field defect,or intracranial infection occurred after operation.There were 7 cases of blurred vision or homonymous hemianopsia and 2 cases of ear numbness after operation,which were not completely recovered after rehabilitation physiotherapy.Non-infected cerebrospinal fluid leakage occurred in 3 cases,and was recovered after rehabilitation treatment.The postoperative histopathologic examination confirmed 17 cases of malignant tumors(including 11 cases of germinoma,2 cases of pineal blastoma,3 cases of low-grade glioma,and 1 case of brain metastasis from lung cancer)and 47 cases of benign tumors(including 20 cases of meningiomas,12 cases of arachnoid cyst,5 cases of pineal parenchyma tumor,5 cases of cholesteatoma,3 cases of lymphoma,and 2 cases of vascular malformation).In 17 cases of malignant tumors,4 cases were treated with gamma knife,7 cases received radiotherapy,4 cases received chemotherapy,and 2 cases received radiotherapy and chemotherapy.The follow-up was don

关 键 词：松果体区肿瘤 神经内镜 手术 

分 类 号：R739.41[医药卫生—肿瘤]