大型颅咽管瘤的显微手术治疗

目的:结合颅底手术入路提高鞍上、三脑室、脚间池大型颅咽管瘤的手术全切除率,提高疗效。方法:采用不同颅底手术入路显微手术切除37例鞍上、三脑室、脚间池大型颅咽管瘤。结果:肿瘤全切除35例,次全切除2例。术中解剖保留垂体柄31例,所有患者术后伴有不同程度一过性尿崩、动眼神经麻痹10例。全部病例平均随访3年,复发1例。结论:对位于鞍上、三脑室和脚间池的大型颅咽管瘤应根据肿瘤的不同生长方向采用相应的手术入路,充分暴露鞍区各脑池、视神经、前循环及其穿通支和三脑室底部等结构,对脑组织和脑神经牵拉小,术后并发症少且易控制,可取得较好的手术治疗效果。

The Microsurgical Management of Giant Craniopharyngiomas

Aim:Combining the skull base approach, to raise the removal degree and to improve the postoperative results of the giant craniopharyngiomas protruding from the suprasellar region into the third ventricle and basal cistern . Methods:37 patients with giant craniopharyngiomas within the third ventricle and basal cistern were microsurgically operated by different approach in our group. Results:Total removal of the lesion was achieved in 35 cases, subtotal in 2. The pituitary stalks were reserved in 31 cases. All patients were suffered from temporary diabetes insipidus. 10 patients have transient oculomotor never palsy. Follow-up duration was 3 years and one case recurred. Conclusion:The suitable approach can be used for the operation of large craniopharyngiomas protruding from the suprasellar region into the third and basal cistern, and the approach can open a larger volume of access to the surgeon. It can achieve better exposure of basal structures (such as the optic nerve, the hypothalamus and its perforating arteries, the floor of the third ventricle, etc) with less brain and cranial nerve retraction. These approaches are safe and efficient with low incidence of postoperative complications.