改良Poppen入路及神经导航辅助下切除松果体区肿瘤

目的探讨利用改良的Poppen入路及神经导航引导下切除松果体区肿瘤的实用性和临床疗效。方法回顾性分析2003年2月～2008年10月15例松果体区肿瘤临床资料。全部病人均在神经导航辅助下经改良的Poppen入路行肿瘤切除，手术策略是最大限度切除肿瘤，解除脑脊液循环梗阻，保护好肿瘤周围重要结构。结果肿瘤全切13例，次全切除2例。1例术后出现交通性脑积水，行脑室-腹腔分流术好转。病理结果：胶质瘤7例、脑膜瘤4例、生殖细胞瘤2例、畸胎瘤2例。术后随访3个月～2年，13例恢复良好，2例遗留部分视力、视野损害。结论改良Poppen入路的优点是路径短，减少对枕叶的牵拉，切开小脑幕后大多可获得较好的肿瘤显露，以最大程度切除肿瘤。神经导航能够引导术者行枕角穿刺和进入手术区，减少副损伤，同时对判定肿瘤切除程度具有较大帮助。

Neuronavigation-assisted resection of pineal region tumors by improved Poppen approach

Objective To explore the practicability and clinical effects of Neuronavigationassisted resection of pineal region tumors by improved Poppen approach. Methods 15 patients including 6 male and 9 female patients were collected in the study. All the patients were performed neuronavigation-assisted tumor resection through improved Poppen approach. The strategy of the surgery is to relieve the obstruction of CSF circulation by tumor removal as much as possible and keep vital neural structure surrounding the tumor intact. Results Total and subtotal removal of the tumor were achieved in 13 and 2 patients. One patient was performed V-P shunt because of postoperative communicating hydrocephalus. Pathological diagnosis is that there are gliomas in 7 patients, meningiomas in 4, germ cell tumors in 2 and teratomas in 2. The following-up from 3 months to 2 years revealed that 13 patients had a good recovery and 2 suffered from visual defect. Conclusion Improved Poppen approach has a shorter surgical route and provide more gentle brain retraction compared with typical Poppen approach. Pineal region tumors can be fully exposed and removed through opening or removing part of tentorium. With the assistance of neuronavigation system, neurosurgeon can be guided into the surgical field, perform occipital drain directly and has a objective judgement of tumor resection.