颅咽管瘤的显微手术治疗及疗效评估

目的探讨显微手术治疗颅咽管瘤的手术入路及手术疗效。方法回顾性分析43例颅咽管瘤病人的临床资料,采用经鼻蝶入路7例,翼点入路32例,额底经纵裂终板入路2例,经胼胝体前部入路2例。评估病人手术前后神经功能、垂体功能、视功能评分。结果肿瘤全切除32例(74%),次全切除9例(21%),部分切除2例(5%)。术后发生电解质紊乱31例,双侧硬脑膜下积液1例,继发颅内硬脑膜外血肿1例,死亡2例。随访4~90个月,平均28个月。肿瘤复发3例,其中再次手术治疗2例,γ-刀治疗1例。手术前后神经功能、视功能变化不明显,垂体功能障碍发生率明显增加(P<0.05)。结论颅咽管瘤应根据肿瘤部位、生长方式及术者经验选择合适的手术入路,术后垂体功能易受影响。

Microneurosurgical treatment and therapeutic efficacy assessment of craniopharyngioma

Objective To explore the surgical approach and outcome of craniopharyngioma by microsurgery.Methods Clinical data of 43 patients with craniopharyngioma were analyzed retrospectively.The surgical approach included transsphenoidal approach in 7 cases,pterional approach in 32,and laminal terminal approach through frontobasal interhemispheric fissure in 2 and anterior transcallosal approach in 2.The neurological,visual and pituitary functions were assessed before and after the operation.Results Total tumor removal was achieved in 32 cases（74%）,subtotal removal in 9（21%） and partial removal in 2（5%）.Electrolyte disturbance occurred in 31 cases postoperatively,bilateral subdural effusion in 1 and epidural hematoma in 1,and 2 patients died.The patients were followed up for mean period of 28 months,ranged from 4 to 90 months.Tumor recurrence was found in 3 cases,including reoperation in 2 and γ-knife treatment in 1 case.The pituitary dysfunction significantly increased postoperatively（P 0.05）,and no significant changes in neurological and visual function after treatment.Conclusions The choice of surgical approach should base on the location and growth pattern of craniopharyngioma and the experience of surgeon.The pituitary function is apt to be impaired during the operation.