摘要
目的探讨枕部经小脑幕（Poppen）入路显微手术切除松果体区肿瘤术中直视下第三脑室底造瘘术的技巧及疗效。方法回顾性分析5例松果体区肿瘤的临床资料,均合并非交通性脑积水。病人均采用Poppen入路切除肿瘤,在显微镜直视下行第三脑室底造瘘术。结果肿瘤均达显微镜下全切除,复查MRI未见肿瘤残余,矢状位可见造瘘口有脑脊液流动信号,脑积水均缓解。病理检查显示：成熟畸胎瘤1例,非成熟畸胎瘤2例,混合性生殖细胞瘤2例;4例恶性肿瘤术后均行放、化疗。术后并发眼球运动障碍1例,短暂性尿崩症1例。随访3~8个月,未出现肿瘤和脑积水复发。结论 Poppen入路切除松果体区肿瘤术后仍有一定比例的脑积水发生,术中直视下行第三脑室底造瘘术可避免术后脑积水的发生,值得临床推广。
Objective To investigate the surgical techniques for and efficacy of intraoperative direct third ventriculostomy in pineal region tumor surgery via occipital transtentorial（Poppen） approach.Methods Clinical data of 5 patients with pineal region tumors and non-communicating hydrocephalus were analyzed retrospectively.Tumor resection via Poppen approach and intraoperative third ventriculostomy under microscope were performed in all the patients.Results Total tumor resection under microscope was achieved in all the cases.Postoperative MRI scan showed no residual tumors,while the signal of CSF flow could be observed at the stoma area in sagittal view,and the symptoms of hydrocephalus were all relieved.The diagnosis was established by postoperative pathological analysis,including 1 mature teratoma,2 immature teratomas and 2 mixed germinomas.Radiotherapy and chemotherapy were performed in 4 malignant tumors postoperatively.The postoperative complications were as follows： ocular motor disorder in 1 case and transient diabetes insipidus in 1.During a follow-up period ranged from 3 to 8 months,no tumor and hydrocephalus recurred.Conclusions Postoperative hydrocephalus may occasionally occur in some cases of pineal region tumor resection via Poppen approach,but can be prevented by intraoperative third ventriculostomy under direct vision.
出处
《中国微侵袭神经外科杂志》
CAS
北大核心
2011年第5期197-199,共3页
Chinese Journal of Minimally Invasive Neurosurgery
关键词
松果体瘤
脑积水
枕部经小脑幕入路
造口术
Pinealoma
hydrocephalus
occipital transtentorial approach
ostomy
