经额侧脑室脉络膜裂入路在丘脑胶质瘤切除术中的应用分析  

Application analysis of the transfrontal ventricle choroidal fissure approach in thalamic glioma resection

作　　者：牟磊[1] 秦军[1] 雷军荣[1] 陈志明[1] 冯驰[1] 刘俊 Mou Lei;Qin Jun;Lei Junrong;Chen Zhiming;Feng Chi;Liu Jun(Department of Neurosurgery,Shiyan Taihe Hospital,Shiyan 442000,China)

机构地区：[1]十堰市太和医院神经外科,十堰442000

出　　处：《中华神经外科杂志》2024年第11期1136-1141,共6页Chinese Journal of Neurosurgery

摘　　要：目的探讨经额侧脑室脉络膜裂入路在丘脑胶质瘤切除手术中的应用效果。方法回顾性分析2017年1月至2023年10月十堰市太和医院神经外科采用经额侧脑室脉络膜裂入路切除术治疗的21例丘脑胶质瘤患者的临床资料。手术通过额中回进入侧脑室体部, 术中4例通过脉络膜裂内侧进入第三脑室切除肿瘤, 17例通过脉络膜裂外侧切除丘脑肿瘤, 肿瘤切除过程在黄荧光染色技术辅助下进行。根据术后头颅MRI评估肿瘤切除率。患者出院后, 通过电话等追踪其后续治疗方案和预后情况。结果 21例患者中, 肿瘤全切除11例(52.4%), 次全切除4例(19.0%), 大部切除5例(23.8%), 活组织检查1例(4.8%)。术前存在梗阻性脑积水的11例患者中, 8例术后脑积水明显缓解, 相关的头痛及记忆力障碍明显改善;3例术前一侧肢体轻偏瘫的患者中, 2例术后短期内症状较前改善。术后电解质紊乱3例;新发不同程度肢体瘫痪3例。2例患者在术后因脑积水行脑室钻孔+Ommaya囊置入术, 3例患者在术后1~2个月行脑室-腹腔分流术。21例患者术后的随访时间[M(范围)]为11个月(6周至73个月)。至末次随访, 患者死亡15例, 其生存期[M(范围)]为10个月(6周至24个月);6例存活。存活患者中, 弥漫性星形细胞瘤2例, 分别于术后6、10个月复发, 均再次行手术后规律放、化疗且肿瘤未复发;胶质母细胞瘤1例, 于术后7个月复发, 未行进一步治疗;间变少突星形细胞瘤2例, 术后规律放、化疗, 随访均未见肿瘤复发;毛细胞型星形细胞瘤1例, 随访73个月未见肿瘤复发。结论采用经额侧脑室脉络膜裂入路可切除侵犯整个丘脑、第三脑室、以及双侧丘脑的胶质瘤, 肿瘤切除率较高、并发症较少, 可有效缓解患者部分短期症状。Objective To investigate the effect of transfrontal ventricle choroidal fissure approach in thalamic glioma resection.Methods The clinical data of 21 patients with thalamic glioma who underwent transfrontal ventricle choroidal cleft approach in the Neurosurgery Department of Shiyan Taihe Hospital from January 2017 to October 2023 were retrospectively analyzed.Surgery was performed through the middle frontal gyrus into the body of the lateral ventricle.During the operation,based on the positional relationship between the tumor and the choroid plexus,4 cases of tumors with the main body located in the third ventricle were resected through the medial side of the choroidal fissure into the third ventricle,and 17 cases of thalamic tumors were resected through the lateral side of the choroidal fissure.The tumor resection process was assisted by yellow fluorescent staining technology.The tumor resection rate was evaluated by postoperative MRI images.Afer discharge,follow-up treatment plan and prognosis were tracked by phone,etc.ResultssAmong the 21 patients,11 cases(52.4%)had total tumor resection,4 cases(19.0%)had subtotal resection,5 cases(23.8%)had majority resection,and 1 case(4.8%)had biopsy.Among the 11 patients with hydrocephalus before surgery,8 patients had significant relief of hydrocephalus after surgery,and the related headache and memory impairment were significantly improved.Among the 3 patients with hemiparesis on one side of the limb,2 patients were improved in the short term after surgery.There were 3 cases of postoperative electrolyte disorders and 3 cases of new postoperative limb paralysis of varying degrees.Two patients underwent ventricular dilling+Ommaya capsule placement due to hydrocephalus after surgery,and three patients underwent ventriculo-peritoneal shunt 1 to 2 months after surgery.The postoperative follow-up time[M(range)]of 21 patients was 11 months(6 weeks to 73 months).By the last follow-up,15 patients had died,and their survival period[M(range)]was 10 months(6 weeks to 24 months);6 pa

关 键 词：丘脑 神经胶质瘤 显微外科手术 脉络膜 

分 类 号：R739.4[医药卫生—肿瘤]