侧脑室内肿瘤的显微外科治疗(附28例报告)

目的探讨侧脑室内肿瘤的临床特征和个体化显微手术策略及疗效。方法回顾性分析2002年9月至2009年6月手术治疗并经病理证实的28例侧脑室内肿瘤患者的临床资料。结果肿瘤全切除22例,次全切3例,大部分切除3例。经病理学证实室管膜瘤8例,脉络丛乳头状瘤4例,脑膜瘤6例,少枝胶质细胞瘤4例,星形细胞瘤3例,中枢神经细胞瘤2例,胶质母细胞瘤1例。1例因术后硬膜下血肿再次手术,7例因脑积水而行脑室-腹腔分流术,5例术后出现颅内感染,1例因严重感染并脑积水死亡。术后配合放疗和/或化疗19例。术后随访6个月至3年,2例轻残,10例生活自理,15例可参加日常工作。结论侧脑室内肿瘤的位置、大小和血供影响手术入路、疗效和病人预后。适宜的手术入路和显露,恰当的导航辅助可避免损害脑功能,提高肿瘤切除程度;恶性肿瘤术后行个体化放疗和/或化疗,可显著改善病人预后。

Microsurgery for lateral ventricle tumors (a report of 28 cases)

Objective To research the clinical characteristics of the lateral ventricle tumors and microsurgical technique to treat them in order to improve curative effect on them.Methods The clinical data of 28 patients with lateral ventricle tumors who underwent microsurgery in our hospital from September,2002 to June,2009,were analyzed retrospectively,including the clinical features,diagnosis, and treatment of the lateral ventricle tumors and treatment outcomes.Results Of 28 patients with lateral ventricle tumors,22 received total resection of the tumors,3 subtotal and 3 partial.The pathological examination proved that of 28 patients,8 suffered from ependymomas,4 choroids plexuspapillomas,6 meningiomas,4 oligodendrogliomas,3 astrocytomas,1 glioblastoma and 2 central neurocytomas.One patient died from postoperative intracranial infection and hydrocephalus,Nineteen received postoperative chemotherapy and/or radiotherapy.Of 27 patients followed up from 6 months to 3 years,2 were slightly disabled,10 could care of themselves,15 returned to normal work.Conclusion The choice of surgical approach and prognosis of the patients with lateral ventricle tumors were influenced by the site,size and vascularity of the tumors.Appropriate operative approach,satisfactory exposure of the tumors and proper application of neuronavigator may increase the extent of tumors resection.The prognoses in the patients with manlignant lateral ventricle tumors may be improved by individualized radiotherapy and/or chemotherapy after the surgery.