56例儿童颅咽管瘤的显微手术治疗及随访

目的：探讨儿童颅咽管瘤显微手术方法,术后并发症的防治及复发的因素。方法：回顾性分析我院2000年1月至2010年12月儿童颅咽管瘤手术病例56例。分别采用经翼点入路28例（50%）、经额下入路14例（25%）、经前额纵裂入路6例（10.7%）,经胼胝体-透明隔间腔-穹隆间入路5例（8.9%）,皮层造瘘入路3例（5.3%）。结果：全切除＋次全切除38例（67.9%）、大部切除17例（30.4%）,围手术期死亡1例（1.7%）。术后并发症主要为尿崩症、血电解质紊乱及癫痫。结论：恰当地选择手术入路、术中娴熟的显微神经外科操作、术后积极防治并发症,是影响颅咽管瘤复发及预后的关键因素。

Microsurgical treatment and follow-up of 56 cases pediatric 56 craniopharyngiomas

Objective：To explore the microsurgical methods for treating craniopharyngiomas,the prevention of complications and the factors influencing recurrence.Methods： From January 2000 to December 2010,56 cases of pediatric craniopharyngioma undertook microsurgery.Five different approaches were used,including the pterional approach in 28 cases（50%）,the subfrontal approach in 14 cases（25%）,the transfrontal longitudinal fission approach in 6 cases（10.7%）,the transcallosum interfornix approach in 5 cases（8.9%）,and transcortical approach in 3 cases（5.3%）.Results： Total or subtotal resection was performed in 38 cases（67.9%）,and partial removal was performed in 17 cases（30.4%）.Perioperative death in 1 case（1.7%）.Major postoperative complications were diabetes insipidus,blood electrolyte disorder and epilepsy.Conclusion： The proper choice of operative approach,skillful intraoperative microsurgical performance and the active postoperative prevention of complications are key factors influencing the recurrence and prognosis of craniopharyngioma.