下丘脑错构瘤显微外科手术治疗（附43例报告）

目的 探讨下丘脑错构瘤的手术治疗。方法 43例下丘脑错构瘤中，男26例，女17例；首发症状为性早熟24例(55．8％)，痴笑14例(32．6％)，癫痫大发作5例(11．6％)；下丘脑内型24例(55．8％)，下丘脑旁型19例(44．2％)；经翼点入路38例，经胼胝体穹隆间入路4例，经终板入路1例。结果 本组43例，全切除19例(44．2％)，近全切除1例(2．3％)，大部切除12例(27．9％)，部分切除11例(25．6％)；19例下丘脑旁型全切除16例(84．2％)，24例下丘脑内型仅3例(12．5％)全切除；术后动眼神经麻痹5例(11．6％)，肢体轻瘫2例(4．7％)，硬膜下积液1例(2．3％)。所有病人随诊4至102个月，平均随诊29个月，痊愈19例(44．2％)，好转22例(51．2％)，无效2例。结论 翼点入路对于下丘脑旁型错构瘤暴露较好，全切率高；而对于下丘脑内型错构瘤因显露不佳而全切困难，采用经胼胝体穹隆间入路手术较为合理。

Microsurgical Treatment of Hypothalamic Hamartoma (Report of 43 cases)

Objective To study the microsurgical treatment of hypothalamic hamartoma(HH).Methods Of43patients with HHs undergoging surgery,26were male and17female.The initial sign was precocious puberty in24cases(55.8%),gelastic epilepsy in14(32.6%)and generalized seizure in5(11.6%).According to the Arita's classification,24cases were the intrahypothalamic type and19the parahypothalamic type.Thirty-eight patients were operated on via pterional approach,4via transcallosal approach and1via translamina terminalis approach.Result Of43patients with HHs,19received total resection of the HHs(44.2%),1subtotal(2.3%),12greatly partial(27.9%)and11partial(25.6%).The tumors were totally resected in16(84.2%)of19patients with the parahypothalamic hamartomas and in only3(12.5%)of24with the intrahypothalmic hamartomas.After the surgery,5patients(11.6%)developed temporary oculomotor nerve palsy,2light hemiparesis and1subdural hydroma.Of43patients followed up from4to102months(mean,29months)after the operation,19(44.2%)were cured,22(51.2%)significantly improved in the clinical symptoms and2unchanged.Conclusions The pterional approach is well suited to resection of the parahypothalamic hamartomas because of well exposure and higher total resection rate,while the transcallosal approach is more suitable for the intrahypothalamic hamartomas than the pterional approach.