经额叶侧脑室脉络膜裂入路丘脑胶质瘤切除术

目的 研究经额叶侧脑室脉络膜裂入路切除丘脑胶质瘤的手术方法.方法 采用经额叶侧脑室脉络膜裂入路切除丘脑胶质瘤20例,在冠状缝前约1.5 cm、冠状缝后不超过1 cm内分离额上沟并切除部分额中回,进入侧脑室体部.根据丘脑肿瘤主体与脉络膜裂的关系,4例在脉络膜裂的内侧纵形进入第三脑室,切除突出于第三脑室的丘脑肿瘤;16例在脉络膜裂的外侧切除丘脑肿瘤.结果 1例肿瘤切除范围小于50%,余19例切除范围大于90%;病理结果:胶质瘤Ⅱ级3例,Ⅲ级9例,Ⅳ级8例.围手术期死亡1例.随访无癫痫发生,GOS评分:良好16例,重残1例,死亡2例.结论 丘脑胶质瘤的手术仍存在较大的困难,采用经额叶侧脑室脉络膜裂入路切除丘脑胶质瘤,取得较理想的效果.

Resection of thalamic gliomas via transcortico-ventriculo-choroidal approach

Objective To evaluate the effect of surgical treatment of thalamic gliomas via transcortico -ventriculo -choroidal approach. Methods 20 cases of thalamic gliomas were included in this group. The part of middle frontal gyrus was removed to get to the lateral ventricule and from there, according to the direction of the tumor encroaching and relationship with choroidal fissure, the tumor was removed directly or through the third ventricle. Results Partial resection ( less than 50% ) was performed in 1 case. Subtotal resection (more than 90% ) was performed in 19 cases. 3 tumors were low -grade gliomas, 17 high - grade. There were two postoperative death. During follow - up period, 16 cases lived in good neurological condition, one severe condition who needed help completely. Another case died of glioblastoma multiforme. Conclusions Transcortico - ventriculo - choroidal approach is safe and effective for getting a good view in the surgical treatment of thalamic glioma.