经枕部后纵裂-天幕入路切除松果体区及三脑室后部肿瘤  

Resection of tumors in pineal region and posterior third ventricle via occipital interhemispheric transtentorial approach

作　　者：王雷[1] 刘仁忠[1] 熊晓星[1] 王峻[1] 连海伟[1] 余信远[1] 邵灵敏[1] 简志宏[1] WANG Lei;LIU Renzhong;XIONG Xiaoxing;WANG Jun;LIAN Haiwei;YU Xinyuan;SHAO Lingmin;JIAN Zhihong(Dept.of Neurosurgery,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China)

机构地区：[1]武汉大学人民医院神经外科,湖北武汉430060

出　　处：《武汉大学学报（医学版）》2024年第3期305-310,共6页Medical Journal of Wuhan University

基　　金：湖北省卫生健康委员会科研项目(编号:WJ2021M148)。

摘　　要：目的:探讨经枕部后纵裂-天幕入路切除松果体区及三脑室后部肿瘤的经验和疗效。方法:回顾性分析2019年5月至2022年1月收治的12例松果体区及三脑室后部肿瘤患者的临床资料,观察其临床疗效。结果:病理结果示生殖细胞肿瘤3例(其中单纯生殖细胞瘤2例),星形细胞瘤2例,胶质母细胞瘤1例,松果体细胞瘤2例,表皮样囊肿3例,小细胞神经内分泌癌(肺来源)1例。肿瘤全切10例(83.3%),次全切2例(16.7%)。无死亡病例。所有病例中,5例患者在切除肿瘤前行脑室外引流术,切除肿瘤后行三脑室底造瘘或终板造瘘缓解脑积水(其中2例在内镜下行造瘘术)。术后1例患者脑室外引流管拔除不能,行脑室-腹腔分流术(VPS)治疗后好转。结论:经枕部后纵裂-天幕入路能够有效切除松果体区及三脑室后部肿瘤,切除肿瘤后可行三脑室底造瘘或终板造瘘缓解脑积水,值得推广。Objective:To investigate the clinical effect of resection of pineal region and posterior third ventri⁃cle tumors via occipital interhemispheric transtentorial approach.Methods:The clinical data of 12 pa⁃tients with the pineal region and posterior third ventricle tumors from May 2019 to January 2022 were re⁃trospectively studied,and the clinical curative effect was observed.Results:Pathological results showed that there were 3 cases of germ cell tumor(including 2 cases of single germinomas),2 cases of astrocytoma,1 case of glioblastoma,2 cases of pineocytomas,3 cases of epidermoid cysts,and 1 case of small cell neuroendocrine carcinoma(lung origin).Total tumor resection was performed in 10 cases(83.3%)and subtotal resection in 2 cases(16.7%).All cases were survived after operation.Among the 12 cases,5 cases underwent extraventricular drainage by drilling before tumor resection,and after tumor resection,they underwent a third ventriculostomy or endplate ostomy to relieve hydrocephalus(2 of them underwent endoscopic ostomy).One patient still had hydrocephalus after the oper⁃ation,which was treated by a ventriculoperitoneal shunt(VPS).Conclusion:The occipital interhemi⁃spheric transtentorial approach can effectively remove the tumors in the pineal region and posterior part of the third ventricle.After the tumors are removed,the third ventriculostomy or endplate osto⁃my can be used to relieve hydrocephalus,which is worthy of promotion.

关 键 词：松果体区肿瘤 三脑室后部肿瘤 手术入路 显微手术 

分 类 号：R739.41[医药卫生—肿瘤]