第三脑室颅咽管瘤的手术治疗

目的探索手术切除第三脑室颅咽管瘤的适应证、方法、并发症预防及预后。方法对我科2000年1月至2004年4月期间收治并采取经皮质-侧脑室入路切除的38例第三脑室颅咽管瘤，结合患者术前症状和体征、影像学特点、手术效果、随访情况等进行回顾性分析。结果38例颅咽管瘤采用经皮质-侧脑室入路切除肿瘤，其中3例联合翼点入路，手术死亡率为0，达到术中全切的为28例（73．7％）。术后癫痫发作和术区硬脑膜下积液分别为2例（5．3％）和4例（10．5％），患者术后综合效果良好。平均随访26．3个月，7例（18．9％）患者复发。结论经侧脑室入路能安全切除部分第三脑室颅咽管瘤，死亡率、致残率低，术后无严重并发症，手术效果好。

Operative treatment of craniopharyngiomas located in the third ventricle

Objective To investigate the indications, techniques, outcomes and complications of operative treatment for the craniopharyngiomas located in third ventricular.Methods From January 2000 to April 2004, 97 patients with craniopharyngioma admitted at our department, 38 of which carried tumors located mainly in the third ventricle. Based on clinical features, 38 cases underwent transcortical-transventricular approaches, including trans-foramen of Monro, middle of septum pellucidum or choroidal fissure. The clinical dada including patients' symptoms, imaging features, outcomes and follow-up were retrospectively analyzed.Results There was no serious surgical mortality. Epileptic seizures occurred in 2 patients, and subdural fluid collections in 4 patients. The mean follow-up period was 26.3 months. The rate of recurrences was 18.9% (7 cases). Conclusion The transcortical-transventricular approach can be used safely to excise parts of third ventricle craniopharyngiomas with low risk of mortality and morbidity. The postoperation complications are well-controlled and overall outcomes are good in most patients.