颅咽管瘤侵袭第三脑室的方式对手术切除的影响

Objective To assess the impact of the positional relationship between the large craniopharyngiomas and the third ventricle on the outcome of surgical resection of the tumors. Methods In 72 cases of craniopharyngiomas, the tumors were classified into two types according to the radiographic and surgical findings defining the relationship between the tumors and the third ventricle. For each type of tumors, 3 grades were classified based on the tumor size, texture, and infiltration pattern of the third ventricle. The extend of tumor removal was confirmed by both intraoperative evaluation and postoperative CT or magnetic resonance imaging. The correlation between the degree of hypothalamus invasion and the extend of tumor removal was analyzed in all the cases. Results The craniopharyngiomas were classified into two types, namely those residing in the third ventricle (7 cases) and those invading the third ventricle(65 cases). The degree of tumor resection was significantly different between the 3 grades: total tumor removal was achieved in 95.7% of grade Ⅰ cases, in 80.0% of grade Ⅱ cases, and in only 47.4% of grade Ⅲ I cases (P<0.05). conclusion Understanding of the anatomical relationship of the tumor to the third ventricular floor can be great value for improving the outcome of surgical resection of large craniopharyngiomas.     

内耳道及面、前庭蜗神经的膜性结构显微解剖研究及其意义

目的：详细了解桥小脑角蛛网膜的分布为认识听神经瘤和其手术提供解剖学依据。方法：采用10％福尔马林固定的胎儿（28．39周）尸头标本11例22侧，利用手术显微镜和常规组织切片染色方法观察内耳道及面、前庭蜗神经的膜性结构分布情况。结果：手术显微镜下见桥小脑池蛛网膜明显向内耳道内延续占81．81％（18侧），另18．19％（4侧）的蛛网膜向内延续的同时与内耳道口及神经发生部分的粘连；72．73％（16侧）的内耳道口及其附近存在大量的蛛网膜小梁与面、前庭蜗神经相连。组织切片发现100％（22侧）的内耳道内蛛网膜贴附在内耳道骨质表面延续至内耳道底部；面、前庭蜗神经之间互相独立，只有神经外膜分隔。结论：听神经瘤为蛛网膜内的结构；熟悉内耳道及面、前庭蜗神经的膜性结构有助于提高听神经瘤手术水平。     

中心静脉导管在持续腰大池脑脊液引流术中的应用

目的观察中心静脉导管在持续腰大池脑脊液引流术中的应用效果。方法将86例蛛网膜下腔出血病人被随机分为2组,分别采用硬膜外导管及中心静脉导管进行持续腰大池引流,比较置管术中和术后并发症的发生情况。结果两种导管一次性置管成功率均较高,但在置管过程中均易出现下肢及会阴部异感不适等神经刺激症状,组间比较无显著性差异（P〉0．05）;与硬膜外导管组相比,中心静脉导管组出现引流不畅、导管脱落、感染及脑脊液漏等不良反应明显降低（P〈0．05或P〈0．01）。结论中心静脉管能保证引流通畅,容易控制流速和流量,适合持续腰大池引流术的需要。     

颅咽管瘤侵袭第三脑室的方式对手术切除的影响

目的 探讨大型颅咽管瘤与第三脑室的关系在肿瘤切除手术中的意义. 方法 南方医科大学南方医院神经外科白1997年1月至2003年1月共采用手术治疗大型颅咽管瘤患者72例.根据肿瘤的影像学表现及手术所见对其进行分类,每一类肿瘤根据大小及其与第三腩室底的关系分为3级,根据术中判断和术后CT和(或)MPd增强扫描结果确定颅咽管瘤手术切除程度,分析肿瘤分级与手术切除程度的关系. 结果颅咽管瘤总体上可以分为第三脑室内型(本组7例)和第三脑室累及型(本组65例)两大类;手术切除程度在不同分级肿瘤间总体分布位置不同,差异有统计学意义(P<0.05). 结论 明确大型颅咽管瘤与第三脑室底及下丘腩结构间的关系对提高大型颅咽管瘤手术疗效有重要意义.     

急性颅脑创伤后垂体前叶激素变化及其相关因素

目的探讨颅脑损伤后患者的垂体前叶激素水平变化规律和颅脑损伤轻重分级的相关性,并探讨其对颅脑损伤预后的影响。方法回顾性分析67例颅脑损伤患者外伤后测得的垂体前叶激素水平,按照GCS积分分成轻型、中型、重型颅脑损伤组,并对所有患者随访半年。结果中、重型颅脑损伤急性期血清PRL、FT4含量显著升高,而LH、FSH、FT3含量显著降低;部分患者受伤72h后及3月后复测,上述指标逐渐恢复正常。颅脑损伤病情稳定期垂体前叶激素的LH／FSH、GH、ACTH、TSH缺乏的发生率分别为25．0％、26．0％、7．8％和4．2％。结论颅脑损伤患者急性期内分泌功能有异常变化,垂体前叶激素水平与损伤轻重程度相关,与患者预后相关。     

视交叉后颅咽管瘤的手术治疗

目的探讨视交叉后部颅咽管瘤的显微手术经验。方法根据影像学所示肿瘤生长部位及扩展方向选择适当手术入路,对84例视交叉后部颅咽管瘤病人进行手术切除,并对术中技术要点及术后反应进行分析。结果本组全切除63例(75.0%),近全切除20例(23.8%),大部切除1例(1.2%)。术后最常见的肿瘤残留部位是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(72例,85.7%)及低钠、高钠血症(63例,75.0%)。围手术期死亡2例(2.4%)。对64例随访5年,复发9例。结论根据肿瘤生长方向及大小选择合适的手术入路,多数颅咽管瘤可以得到良好的长期控制。     

颅咽管瘤侵袭第三脑室的方式对手术切除的影响

Objective To assess the impact of the positional relationship between the large craniopharyngiomas and the third ventricle on the outcome of surgical resection of the tumors. Methods In 72 cases of craniopharyngiomas, the tumors were classified into two types according to the radiographic and surgical findings defining the relationship between the tumors and the third ventricle. For each type of tumors, 3 grades were classified based on the tumor size, texture, and infiltration pattern of the third ventricle. The extend of tumor removal was confirmed by both intraoperative evaluation and postoperative CT or magnetic resonance imaging. The correlation between the degree of hypothalamus invasion and the extend of tumor removal was analyzed in all the cases. Results The craniopharyngiomas were classified into two types, namely those residing in the third ventricle (7 cases) and those invading the third ventricle(65 cases). The degree of tumor resection was significantly different between the 3 grades: total tumor removal was achieved in 95.7% of grade Ⅰ cases, in 80.0% of grade Ⅱ cases, and in only 47.4% of grade Ⅲ I cases (P<0.05). conclusion Understanding of the anatomical relationship of the tumor to the third ventricular floor can be great value for improving the outcome of surgical resection of large craniopharyngiomas.     

颅咽管瘤侵袭第三脑室的方式对手术切除的影响

Objective To assess the impact of the positional relationship between the large craniopharyngiomas and the third ventricle on the outcome of surgical resection of the tumors. Methods In 72 cases of craniopharyngiomas, the tumors were classified into two types according to the radiographic and surgical findings defining the relationship between the tumors and the third ventricle. For each type of tumors, 3 grades were classified based on the tumor size, texture, and infiltration pattern of the third ventricle. The extend of tumor removal was confirmed by both intraoperative evaluation and postoperative CT or magnetic resonance imaging. The correlation between the degree of hypothalamus invasion and the extend of tumor removal was analyzed in all the cases. Results The craniopharyngiomas were classified into two types, namely those residing in the third ventricle (7 cases) and those invading the third ventricle(65 cases). The degree of tumor resection was significantly different between the 3 grades: total tumor removal was achieved in 95.7% of grade Ⅰ cases, in 80.0% of grade Ⅱ cases, and in only 47.4% of grade Ⅲ I cases (P<0.05). conclusion Understanding of the anatomical relationship of the tumor to the third ventricular floor can be great value for improving the outcome of surgical resection of large craniopharyngiomas.     

颅咽管瘤侵袭第三脑室的方式对手术切除的影响

Objective To assess the impact of the positional relationship between the large craniopharyngiomas and the third ventricle on the outcome of surgical resection of the tumors. Methods In 72 cases of craniopharyngiomas, the tumors were classified into two types according to the radiographic and surgical findings defining the relationship between the tumors and the third ventricle. For each type of tumors, 3 grades were classified based on the tumor size, texture, and infiltration pattern of the third ventricle. The extend of tumor removal was confirmed by both intraoperative evaluation and postoperative CT or magnetic resonance imaging. The correlation between the degree of hypothalamus invasion and the extend of tumor removal was analyzed in all the cases. Results The craniopharyngiomas were classified into two types, namely those residing in the third ventricle (7 cases) and those invading the third ventricle(65 cases). The degree of tumor resection was significantly different between the 3 grades: total tumor removal was achieved in 95.7% of grade Ⅰ cases, in 80.0% of grade Ⅱ cases, and in only 47.4% of grade Ⅲ I cases (P<0.05). conclusion Understanding of the anatomical relationship of the tumor to the third ventricular floor can be great value for improving the outcome of surgical resection of large craniopharyngiomas.     

小儿下丘脑错构瘤的诊断和治疗

目的 探讨小儿下丘脑错构瘤的诊断和显微外科手术治疗.方法 回顾分析1998年1月至2006年12月收治的5例下丘脑错构瘤,男2例,女3例,平均年龄44.4个月.2例主要表现性早熟,1例主要表现为痴笑样癫痫,2例表现为性早熟和痴笑样癫痫,MRI表现为脚问池和鞍上池等信号肿物,无强化,最大直径大小为13.9～21.0 mm.5例患儿均采用右翼点入路显微手术切除错构瘤.结果 5例下丘脑错构瘤均获全切除,病理证实为下丘脑错构瘤,术后患儿性早熟均停止,复查性激素均下降至儿童期水平;2例癫痫症状消失,1例癫痫症状明显减轻,无其他术后并发症.结论 小儿下丘脑错构瘤的症状明显,影像特殊,诊断明确;首选为显微手术切除错构瘤,全切后可治愈.