扩大终板入路切除鞍上第三脑室内外颅咽管瘤的临床疗效分析

目的　探讨扩大终板入路行显微手术切除鞍上第三脑室内外颅咽管瘤的临床效果及安全性。方法　回顾性分析行扩大终板入路显微手术的38例鞍上第三脑室内外颅咽管瘤患者的临床资料，其中男22例，女16例；影像学提示单纯囊性14例，单纯实质性12例，囊实性12例，CT提示肿瘤伴有钙化15例。收集其术前和术后影像学资料、激素水平、视力视野和病理结果等。结果　38例患者中行扩大终板入路显微手术全切34例（89.5%），次全切除为3例（7.9%），部分切除1例（2.6%），无手术相关死亡病例。术后1个月内视力好转或无变化患者31例。术后随访（54.5±7.3）个月，肿瘤复发4例，其中2例接受再次手术治疗，2例接受放射治疗。结论　扩大终板入路显微手术切除鞍上第三脑室内外颅咽管瘤，肿瘤全切率高，术后并发症少且有利于对垂体柄视神经的保护。

Clinical analysis of extended trans-lamina terminalis approach for intra- and extra- ventricular craniopharyngiom

Objective　To investigate the clinical efficacy and safety of extended endplate approach for microsurgical resection of craniopharyngioma inside and outside the suprasellar third ventricle. Methods　The clinical data of 38 cases of craniopharyngioma, including 22 males and 16 females, who underwent extended endplate approach microsurgery for suprasellar third ventricle were retrospectively analyzed. Imaging data suggested that 14 cases were simple cystic disease, 12 cases were simple substantive disease, 12 cases were cystic solid disease, and 15 cases were tumor with calcification indicated by CT. Preoperative and postoperative imaging data, hormone levels, visual field and pathological results were collected. Results　Among the 38 patients, 34 patients (89.5%) received total resection through extended endplate approach, 3 patients (7.9%) received subtotal resection and 1 patient (2.6%) received partial resection. There were no surgery-related deaths. Thirty-one patients showed improved visual acuity or had no change within 1 month after operation. Postoperative follow-up was (54.5±7.3) months, 4 patients had tumor recurrence, including 2 patients who received re-operation and 2 patients who received radiotherapy. Conclusion　Extended endplate approach for microsurgical resection of craniopharyngioma in and out of the third suprasellar ventricle has a high total resection rate, fewer postoperative complications and is beneficial to the protection of pituitary stalk optic nerve.