摘要
目的探讨翼点入路为基础的颅咽管瘤全切除方法，并通过长期随访了解患者生存状态。方法根据肿瘤影像学表现的生长部位及扩展方向将翼点入路进行改良，对121例颅咽管瘤患者进行手术治疗，并对其中83例进行12-84个月的随访。结果本组全切除、近全切率分别为79．3％、19．0％，术后最常见的肿瘤残留部位位于肿瘤与第三脑室底部前端连续处。术后最常见的下丘脑反应为尿崩症（86、8％）及低钠、高钠血症（68、6％），其中高钠血症预示严重的下丘脑反应，但经过处理术后反应多可良好控制。围手术期死亡3例（2．5％）。11例随访期内复发，复发率13％。随访期患者复发最常见于术后2年内。结论根据肿瘤生长方向及大小，选择各种改良翼点入路进行积极的全切除，多数颅咽管瘤可以得到良好的长期控制和生存质量。
Objective To discuss the operative techniques and long-term results of patients who underwent microsurgical resection of craniopharyngioma by using a modified pterional approach. Methods From January 1999 to February 2004, 121 patients were surgically treated for craniopharyngioma via a modified pteronal approach. The imaging features, intraoperative course, and postoperative outcomes of those patients were reviewed. Eighty-three patients were followed up with a term of 12 to 84 months. Results Total removal of the lesion was achieved in 96 cases, twenty-three patients underwent subtotal resection, and two underwent partial removal. The most frequent sites of tumor remnant on the post-operative neruo-imaging studies are anterior parts of the floor of the third ventricle adherent to the hypothalamus. Major postoperative complications included 105 cases of diabetes insipidus （86.8%） , sodium disorder in 86 cases （68.6%） , Hypernatraemia indicate severe hypothalamic damage, most of them can be successfully managed. 3 patients died post-operatively. 11 presented a recurrence of their craniopharyngioma. Turnout recurrences during follow-up tend to occur mainly in the first 2 post-operative years. Conclusion The authors conclude that the modified pterional approach based on the preoperative imaging studies is a valid choice for the radical removal of craniopharyngioma and provided a high rate of long-term control in craniopharyngima.
出处
《中华神经外科杂志》
CSCD
北大核心
2007年第4期246-249,共4页
Chinese Journal of Neurosurgery
关键词
颅咽管瘤
手术入路
手术技巧
预后
Craniopharyngioma
Surgical approach
Surgical technique
Outcome
