经胼胝体-透明隔间腔-穹隆间入路切除下丘脑错构瘤术后合并症

目的 总结经胼胝体-透明隔间腔-穹隆间入路切除下丘脑错构瘤术后合并症和治疗经验.方法 下丘脑错构瘤患者37例,男26例,女11例,男女之比2.4:1.年龄15个月～36岁,平均8.7岁.结果 37例患者有8例术后电解质正常,19例初始异常表现为低钠,10例表现为高钠,并且因低钠2例出现神志淡漠,1例因低钠出现癫痫大发作,1例持续小发作.住院期间另有4例出现癫痫小发作.术后发热25例,其中高热3例,2例一过性多尿,1例一过性高血糖,4例短期近时记忆障碍.结论 经胼胝体-透明隔间腔-穹隆间入路切除下丘脑错构瘤治疗癫痫效果好,术后合并症总体上较轻、可控制,最主要的是血钠变化,远期合并症较少.

Complications after transcallosal transseptal interforniceal resection of hypothalamic hamartoma: analysis of 37 cases

Objective To summarize the post-operative complications of resection of hypothalamic hamartoma (HH) through transcallosal transseptal interforniceal approach. Methods Thirty-seven HH patients, 26 males and 11 females, aged 8.7 underwent resection of the tumor via the transcallosal transseptal interforniceal approach. The symptoms and blood electrolytes were observed. Results After operation blood electrolyte test showed that 8 cases were normal, 19 cases showed hyponatremia as prime abnormality, and 10 cases had hypernatremia primely. Among the 19 cases with hyponatremia transient apathy occurred in 2 cases, general epilepsy occurred in one patient, continuous minor epilepsy occurred in another one, 4 patients suffered minor epilepsy, 25 had fever the temperature of 3 of which were beyond 40 ℃, and 2 had transient diabetes insipidus and 1 had diabetes. Conclusion Resection of HH through the transcallosal transseptal interforniceal approach achieves significant improvement of gelastic seizures with fewer complications. The most common complication is disturbance of serum natrium, which, however, is mild and well managed.