神经内镜在囊性颅咽管瘤治疗中的作用

目的;探讨神经内镜在巨大囊性颅咽管瘤治疗中的作用。方法：对巨大囊性颅咽管瘤伴有梗阻性脑积水的9例患者,应用神经内镜先缩小肿瘤体积、解除梗阻性脑积水并穿通囊内分隔,之后再辅以放射或显微手术切除。结果：9例患者术后颅内压增高症均消失、术前症状改善。影像学复查（CT或MR）见肿瘤均缩小至鞍区、脑积水消失。除1例有暂时多尿及低钠外,余无其他严重并发症。再手术全切除肿瘤的3例患者术后反应明显减轻。结论：对有囊性变并伴有脑积水的巨大颅咽管瘤,先采用神经内镜手术,是提高进一步治疗效果、降低致残率和死亡率的有效方法。     

神经内窥镜在囊性颅咽管瘤治疗的作用

目的探讨神经内窥镜在巨大囊性颅咽管瘤治疗中的作用.方法对巨大囊性颅咽管瘤伴有梗阻性脑积水的9例患者,应用神经内窥镜先缩小肿瘤体积、解除梗阻性脑积水并穿通囊内分隔,然后再辅以放射或显微手术切除.结果9例患者术后颅内压增高症状均消失,术前症状改善.影像学复查(CT或MR)见肿瘤均缩小至鞍区、脑积水消失.除1例有暂时多尿及低钠外,无其他严重并发症.再手术全切除肿瘤的3例,患者术后反应明显减轻.结论对有囊性变并伴有脑积水的巨大颅咽管瘤,先采用神经内窥镜手术,是提高进一步治疗疗效、降低致残率和死亡率的有效方法.     

神经内镜在颅咽管瘤手术治疗中的应用

颅咽管瘤(craniopharyngioma,CP)是一种复发率高、预后不佳的特殊类型颅内原发性良性肿瘤,即使采用手术联合放化疗,治疗效果也不满意。腔内近距离放疗及囊内注射博来霉素等众多新的治疗方案正在研究阶段,目前治疗的首选方法仍是显微外科手术。经鼻蝶入路手术治疗本病至今已有100多年的历史,由于手术器械及设备的进步,神经内镜下经鼻蝶入路已成为重要的治疗术式。本文章结合国内外文献,对神经内镜下经鼻蝶入路治疗颅咽管瘤的相关情况作一综述。     

颅咽管瘤的显微手术治疗

颅咽管瘤为累及下丘脑的良性肿瘤,多发生在鞍上区,肿瘤多为实性或囊性,伴有较多钙化,与周围重要组织结构粘连紧密,手术切除较困难。1995-01-2009-11作者对78例显微手术治疗后颅咽管患者进行回顾性分析,报告如下。     

颅咽管瘤的显微手术治疗

颅咽管瘤为累及下丘脑的良性肿瘤,多发生在鞍上区,肿瘤多为实性或囊性,伴有较多钙化,与周围重要组织结构粘连紧密,手术切除较困难.1995-01- 2009-11作者对78例显微手术治疗后颅咽管患者进行回顾性分析,报告如下.1资料与方法1.1 一般资料 78例患者中男41例,女37例;年龄10～72岁,平均37.1岁;病程1个月～6 a,平均1.4a.1.2临床表现以头痛为首发症状23例,视力降低34例,多饮多尿3例,闭经或月经紊乱7例,阳痿3例,发育迟缓2例,偏瘫2例,另外分别有肢体无力、动眼神经麻痹、记忆力减退和体检中发现各1例.     

颅咽管瘤的显微手术及并发症的治疗分析

我科自1996年以来共手术治疗颅咽管瘤56例,尤其是近2年来应用显微外科技术全部切除疗效满意,现就临床体会总结如下。     

囊性、囊实性颅咽管瘤的立体定向囊内放疗

目的研究CT、MRI引导立体定向囊内放射治疗囊性和囊实性颅咽管瘤的疗效。方法对100例囊性和囊实性颅咽管瘤的囊性部分行CT、MRI引导立体定向囊腔内置入Ommaya,吸除囊液、注入胶体磷酸铬,对囊实性颅咽管瘤的实质部分行伽玛刀治疗。结果全部病例经手术排出囊液后临床症状迅速改善,经囊腔内放疗后6～84个月随访90例病人,CT及MRI扫描显示42例瘤腔持续消失,临床症状消失,恢复正常工作和学习;18例肿瘤显著缩小,症状持续改善;20例肿瘤无明显改变;复发10例,其中再手术6例;死亡7例。结论CT、MRI引导立体定向放射治疗囊性颅咽管瘤安全、有效。     

颅咽管瘤的显微手术治疗

目的探讨颅咽管瘤显微手术治疗的方法和入路.方法回顾性分析32例颅咽管瘤显微手术的方法、并发症和治疗结果,总结临床处置过程中的体会.结果 31例患者经翼点入路、1例经前胼胝体入路完成手术.经术中观察及术后CT和MRI复查证实,肿瘤全切除26例,次全切除3例,部分切除2例.术后出现尿崩症24例,高钠高氯血症18例,低钠血症5例,高热11例.临床痊愈出院12例,好转出院19例,死亡1例. 结论采用显微手术全切颅咽管瘤,效果良好;术前即有明显下丘脑功能损害者,手术风险较大,预后差;鞍区颅咽管瘤采用翼点入路是最佳选择.     

囊性颅咽管瘤内照射治疗进展

关于颅咽管瘤的治疗,多数学者主张行根治术.而对于较大的囊性、多囊性及复发囊性肿瘤,手术根治困难,往往伴有很高的复发率和死亡率.内照射治疗方法简便易行,对病人损伤小,可根治肿瘤并减少囊液分泌.自1952年Leksell首先采用立体定向术向囊内注人胶体~(32)P对囊性颅咽管瘤行内照射治疗以来,治疗方法已有了很大的改进.本文就近年来囊性颅咽管瘤内照射治疗(internal irradia-tion for cystic craniopharyngioma,IICC)情况作一综述.     

显微手术切除治疗颅咽管瘤

目的 探讨颅咽管瘤显微手术切除的方法和入路。方法 45例经显微手术切除的颅咽管瘤中,囊性者34例(有钙化者26例),实质性11例;肿瘤直径2cm或以下者5例,2.1～4.0cm29例,4.1～6.0cm 6例,>6.0cm者5例。4例三脑室内肿瘤经胼胝体前入路,经胼胝体-翼点联合入路2例,39例经右翼点入路切除肿瘤。结果 经术中观察和影像学资料证实,全切除41例,次全切除2例,大部切除2例,随访2月～4年,参加工作或学习者38例,需生活照顾者5例,死亡2例,均系实质性肿瘤。结论早期诊断的颅咽管瘤显微手术全切除,效果理想;巨大、实质性肿瘤且伴有糖尿病者手术危险性很大。翼点入路是鞍区颅咽管瘤显微手术切除的最佳入路。     

神经内窥镜手术治疗小儿脑积水

目的介绍一种治疗导水管狭窄性梗阻性脑积水的新方法.方法经侧脑室-室间孔-三脑室置入神经内窥镜,于三脑室底与脚间池之间造一瘘孔.结果 9例近期疗效好,前囟张力正常,2例改行脑室腹腔分流术.结论神经内窥镜下三脑室底脚间池造瘘是一种安全、有效、并发症少的微创手术.     

Neuroendoscopy in the premature population

The population born prematurely is particularly prone to hydrocephalus. Shunting techniques, whilst still the gold standard, have considerable failure rates and contribute significant morbidity and mortality. The role of neuroendoscopic techniques in the treatment of such patients is explored, and a series of 19 patients born prematurely and operated on neuroendoscopically before their 1st birthdays is described. Received: 8 May 1998     

Treatment Outcomes of Pediatric Craniopharyngioma : A 15-Year Retrospective Review of 35 Cases

Objective

The aim of this study was to describe a single center''s experience in the management of craniopharyngiomas in children over a 15-year period.

Methods

The clinical records of pediatric patients treated for craniopharyngiomas between December 1995 and February 2011 were reviewed. Thirty-five pediatric patients diagnosed with craniopharyngioma were treated, and their medical records and imaging data were analyzed retrospectively.

Results

The mean follow-up duration was 76 months (range, 10-195). Overall survival and local control rates at 10 years were 94.7±5.1% and 37.1±11.9%, respectively. The female-to-male ratio was 16 : 19, and the mean age was 8.6 years (range, 1-17). Initially, gross total resection (GTR) was performed in 30 patients; subtotal resection (STR) followed by radiotherapy was performed in 5 patients. Of the 14 cases that showed recurrence after GTR, 5 patients were treated with GTR, 1 with radiation therapy (RT), 4 with gamma knife radiosurgery (GKRS), and 4 with subtotal resection followed by RT. No patients who underwent RT or GKRS had recurrences. Two cases with recurrence after STR followed by RT were treated with GTR. One patient died of hormonal insufficiency 64 months after the first surgery. The overall median time progression was 51.2 months (range, 3-182) : 49.7 months in the patients who underwent GTR and 60.2 months in the patients who underwent STR followed by RT.

Conclusion

If safe resection is possible, GTR at the initial treatment should be attempted to reduce the tumor recurrence. However, if the tumor recurs after the first surgery, RT or GKRS with/without reoperation may be an effective salvage treatment for recurrent craniopharyngioma.     

锁孔手术切除颅咽管瘤

目的 探讨锁孔入路切除颅咽管瘤的显微手术技术,以最大限度减少手术创伤,并达到完美的治疗效果。方法 采用眉部切口,在眶上额骨作直径2cm左右开颅,应用内镜辅助的显微手术技术切除病变。结果 连续8例颅咽管瘤患者采用眶上锁孔入路技术获治愈。结论 眶上锁孔入路可明显减少手术创伤,提供鞍上区足够的手术空间,并有效地切除病变。     

应用神经内镜手术治疗脑囊虫

目的：探讨应用神经内镜治疗脑囊虫的方法和意义。方法：应用神经内镜探查、冲洗、摘除脑囊虫。结果：10例脑室内囊虫,2例脑实质囊虫（形成囊性占位效应）摘除,2例行脑室－腹腔分流。14例均疗效满意。无明显并发症。结论：用神经内镜治疗服囊虫具有安全、高效、并发症少的优势。     

Cyst fenestration and Ommaya reservoir placement in endoscopic transcortical transventricular approach for recurrent suprasellar cystic craniopharyngioma without ventriculomegaly

The efficacy of the endoscopic transcortical transventricular approach (ETTA) for craniopharyngioma in the third ventricle with hydrocephalus has been reported focusing on its reduced invasiveness. On the other hand, suprasellar craniopharyngioma without ventriculomegaly is generally surgically managed by craniotomy or the endoscopic endonasal approach (EEA). Here, we report an elderly patient who received cyst fenestration and Ommaya reservoir placement in ETTA for recurrent suprasellar cystic craniopharyngioma without ventriculomegaly. The ETTA as a less invasive procedure is feasible in patients not only with intraventricular craniopharyngioma but also with suprasellar craniopharyngioma without hydrocephalus provided a navigational system is applied and the surgeon has ample experience with transcranial endoscopic procedures.     

神经内镜技术治疗脑积水14例报告

目的 分析神经内镜技术应用于治疗脑积水的疗效及价值。方法 回顾性地分析总结了14例脑积水病例，均行神经内镜技术治疗，11例行内镜第三脑室造瘘术(ETV)，1例行分流管侧脑室端校正术，2例交通性脑积水行分流管脑室端校正及脉络丛烧灼术。结果 所有病例均取得了满意的疗效，未出现术后并发症。结论 神经内镜技术治疗脑积水具有微创性、视野好、操作简单等优点，结合神经导航系统，计算机三维成像等新技术，可设计最佳手术人路，避免副损伤，术中往往只需一小骨孔，最大限度地减小了手术创伤。ETV的良好疗效及少有并发症充分显示了神经内镜技术治疗脑积水的优越性。     

颅咽管瘤的微侵袭外科治疗

目的探讨颅咽管瘤的微侵袭治疗方法的选择及并发症。方法46例颅咽管瘤患者,30例行显微手术切除,其中25例行全切除,5例行大部分切除后予r刀治疗;6例行单纯r刀治疗;10例行MRI立体定向囊内放射治疗。结果手术组25例全切除患者,术后21例恢复正常工作,2例需生活照顾,2例死于下丘脑损害;随访2年以上16例,CT或MRI检查未见肿瘤复发。r刀治疗组11例患者临床症状明显改善,随访6～30个月,MRI检查显示4例肿瘤完全消失,5例缩小,2例无变化,无术后并发症。囊腔放疗组10例经手术排除囊液后临床症状明显改善,随访3～30个月,MRI显示3例肿瘤完全消失,7例瘤腔明显缩小,无手术死亡率及严重并发症。结论显微手术全切除颅咽管瘤仍是目前理想的治疗方法,r刀治疗适用实质性和部分实质性,体积较小(<3～4cm)的肿瘤。对囊性体积较大的颅咽管瘤行立体定向囊腔内放疗是一种十分安全有效的方法。     

Craniopharyngiomas in children: surgical experience at Children’s Memorial Hospital

Objectives Craniopharyngioma during childhood poses difficulty in management because of the high incidence of surgical complications and treatment failure. In order to identify less detrimental and more effective treatment, a personal series of craniopharyngioma was reviewed in regard to various clinical factors, patient factors (age and sex), tumor factors (location and extension, relationship with chiasm, and hydrocephalus), and therapeutic modes [extent of resection and radiation therapy (RT)].Materials and methods Fifty-four childhood craniopharyngiomas treated from 1984 to 2003 were reviewed. Preoperative neuroimaging studies were classified depending upon tumor location and extension. In this series of 54 patients, 43 had total tumor resection and 11 had subtotal resection. Of the total resection group, ten showed evidence of residual tumor on postoperative neuroimaging studies. Following the initial resection, 46 did not have RT whereas 8 with subtotal resection received RT.Results There were no surgical deaths. Postoperative complications included pseudoaneurysm in 1, hemiparesis in 3, severe obesity in 5, panhypopituitarism in 50, and worsening of visual function in 7. During follow-up ranging from 12 months to 21 years, 24 patients had recurrence. Of the 33 patients with radiographic total resection, 9 (27.3%) had recurrence. Among the patients with total resection but radiographic residual and those with subtotal resection, the craniopharyngioma recurred in 90% and 100%, respectively. Three (37.5%) of eight patients with subtotal resection with RT had recurrence. Overall recurrence-free survival was 62% at 5 years and 49% at 10 years. The sex and age, location and extension of the tumor, nature of the optic chiasm, and hydrocephalus did not influence survival with statistical significance. However, the extent of surgical resection and use of RT showed significant differences for survival. Patients with total resection had a recurrence-free survival rate of 83% and 70% at 5 and 10 years, respectively. Patients with subtotal resection with RT had 71% at 5 years and 36% at 10 years. Patients who had subtotal resection or radiographically residual tumor without RT had a recurrence-free survival rate of only 9%. Among 22 patients whose recurrent tumor was treated with RT, a second recurrence-free survival rate was 90% at 5 years.Conclusion Total resection provided the best outcome. However, recurrence rates and surgical complications remained high following radical tumor resection. RT was effective for recurrent tumors and should be considered being the primary treatment for recurrences or difficult tumors, which are not amenable to total resections.