经终板入路显微外科手术切除视交叉后颅咽管瘤

目的 探讨经终板入路显微外科手术切除视交叉后累及第三脑室颅咽管瘤的可行性、手术技巧及疗效.方法 回顾性分析34例位于视交叉后累及第三脑室颅咽管瘤病人的临床资料,均采用经终板入路显微手术切除肿瘤.结果 肿瘤全切除30例,次全切除4例.本组死亡1例.术后出现尿崩症、电解质紊乱、垂体前叶功能低下等并发症.术前症状多数不同程度好转.23例随访3～7年,次全切除的病人中术后行伽玛刀治疗3例,随访期间未复发;拒绝放疗1例,术后16个月MRI示肿瘤复发.另19例肿瘤全切除病人随访期间均未复发.结论 经终板入路切除视交叉后累及第三脑室的颅咽管瘤,可取得较好的疗效;精湛的显微外科技巧可避免或减少发生术后并发症.     

经终板入路显微切除视交叉后肿瘤

目的 探讨视交叉后肿瘤的手术入路和显微手术技巧。方法 采用终板入路显微切除11例视交叉后肿瘤，其中颅咽管瘤7例，垂体腺瘤、血管瘤、下丘脑胶质瘤和视交叉胶质瘤各1例。结果 全切除10例、次全切除1例、良好9例、死亡2例。随访2个月至2年未见肿瘤复发。结论 应用娴熟的显微手术技巧，经终板入路彻底切除视交叉后肿瘤对下丘脑无明显损伤，可以取得良好的临床疗效。     

经胼胝体-穹隆间入路切除突入第三脑室内颅咽管瘤

目的 探讨切除鞍上突入第三脑室内颅咽管瘤的显微手术人路及疗效.方法 经胼胝体-穹隆间入路显微手术切除46例突入第三脑室内的颅咽管瘤.结果 肿瘤全切33例,近全切10例,部分切除3例;随访46例,随访时间3个月-15年,其中39例术后恢复正常工作和生活,8例术后复发.结论 经胼胝体-穹隆间入路切除第三脑室颅咽管瘤疗效显著.此入路能最大限度地保护正常脑组织,并在明显提高肿瘤全切率的同时做到较少的术后并发症.     

经终板-翼点入路切除第三脑室前部颅咽管瘤(附7例报告)

目的　探讨第三脑室前部颅咽管瘤的手术入路及术后并发症的防治。方法　经终板 翼点入路切除 7例第三脑室前部颅咽管瘤 ,其中囊性肿瘤 2例 ,实体肿瘤 5例。结果　本组全切除 2例 ,次全切除 4例 ,大部切除 1例。 7例术后均发生水电解质紊乱 ,对症采用口服白开水和使用速尿或口服食盐的方法有效。 2例实体肿瘤死于呼吸衰竭。存活 5例随访 2～ 9年 ,1例次全切除者术后半年死于肺炎 ,另次全切除和全切除者各 2例经CT/MR复查 ,除 1例次全切除者术后 8年 1个月肿瘤复发外 ,其余 3例未见复发。结论　经终板 翼点入路较单纯经终板或翼点入路方便、安全。呼吸衰竭是最严重的并发症 ,术后维持水电解质平衡是治疗的关键。术后常规放疗可以减少肿瘤复发。     

经额底纵裂终板入路切除鞍后、鞍上区及第三脑室前部肿瘤

目的总结经额底纵裂终板入路切除鞍后、鞍上区及第三脑室前部肿瘤的治疗经验。方法回顾性分析32例鞍后、鞍上区及第三脑室前部肿瘤病人的临床资料,其中颅咽管瘤28例,生殖细胞瘤1例,垂体瘤3例。均经额底纵裂终板入路切除肿瘤。结果肿瘤全切除21例,次全切除6例,大部分切除5例;双侧嗅神经均保留29例,垂体柄保留24例。随访30例,时间2个月～2年,仅2例肿瘤大部分切除病人复发再次手术。结论经额底纵裂终板入路适合于切除向鞍后、鞍上区及第三脑室前部生长的肿瘤,术野显露充分,便于保留下丘脑、垂体柄等重要结构,肿瘤全切率高,并发症少,疗效好。     

终板显微解剖及其相关手术入路

终板是脑深部重要的解剖结构,周围比邻视交叉、前交通动脉复合体、下丘脑、穹隆柱等重要组织结构。经终板入路多用于处理颅咽管瘤和位于三脑室前部、压迫终板的肿瘤,以及终板造瘘解除脑积水。熟悉终板的解剖及其与周围组织的关系对于应用显微神经外科技术处理相关病变具有重要意义。     

翼点入路经终板切除鞍区肿瘤的显微外科技术

目的 探索利用终板切开更好地显露肿瘤,争取对颅咽管瘤和巨大垂体瘤、胚胎瘤、脑膜瘤实施全切手术。方法 自1994年至1998年所施行的347例鞍区肿瘤中,有44例需切开终板行肿瘤切除。视交叉前置和侵及三脑室前部的肿瘤是施行终板切开的适应证,此种情况可在术前MR片上获取有益信息。终板切开前,仔细地解剖侧裂池、颈动脉池、视交叉池,分离切断蛛网膜连结是暴露终板的前提条件。沿同侧视束切开终板、注意辨识和保护视交叉及对侧视束是防止术后视力下降、视野缺失的关键。肿瘤的囊内分块切除,联合间隙1、间隙2,牵引剥离肿瘤是既能全切肿瘤,又能防止术后下丘脑、丘脑受损的有效方法。结果终板切开结合间隙1、间隙2切除鞍区肿瘤,全切率达84％(37/44),其中颅咽管瘤全切率为94％(29/31),垂体瘤为89％(8/9)。术后死亡率为14.6％,死因多为癫痫大发作或持续癫痫。结论 终板附近有下丘脑等重要神经结构,此区手术如方法得当不会损伤上述重要结构,并能达到全切肿瘤的目的。     

经额底纵裂入路显微手术切除鞍区肿瘤

目的 探讨经额底纵裂入路显微外科手术治疗鞍区肿瘤的于术方法及手术技巧.方法 应用经额底纵裂入路显微外科手术切除垂体瘤12例,脑膜瘤5例,颅咽管瘤3例,表皮样囊肿1例.结果 垂体瘤伞切除9例,近全切除3例;脑膜瘤SimpsonⅡ级切除5例;颅咽管瘤全切除3例;鞍上表皮样囊肿伞切除1例.结论 经额底纵裂入路对前颅底、鞍区草要解剖结构有良好暴露,有利于术中对大脑前动脉、颈内动脉、前交通动脉,垂体柄、视交叉、下丘脑及重要穿通血管等结构的保护,手术全切率高,术后出现偏瘫、失语、昏迷、尿崩的发生率低.     

颅咽管瘤全切术中的下丘脑功能保护

目的探索手术全切颅咽管瘤的有效方法。方法３０例颅咽管瘤病人中,２８例病人在全麻下行翼点入路,２例额下入路,视交叉前间隙切除肿瘤;结果除１例二次手术病人近全切除外,２９例均达到肿瘤全切。术后２７例参加日常工作,１例需要生活照顾,２例死亡,其中１例死于尿崩症,１例因误吸死亡。结论　术中保护下丘脑神经结构和避免其细小穿通动脉的损伤,对安全切除鞍上和三脑室内颅咽管瘤起重要作用。     

大型颅咽管瘤切除术后并发症的防治

目的 探讨大型（直径大于40mm）颅咽管瘤切除术后并发症的发生情况和有效的防治方法。方法 40例大型颅咽管瘤患者中20例经翼点入路．11例经眶上眉弓锁孔入路．6例经纵裂穹隆间入路，3例经前纵裂终板入路，经鞍区不同解剖间隙切除肿瘤。术中注意保护来自颈内动脉、前后交通动脉和脉络膜前动脉供应下丘脑的穿动脉。肿瘤囊液放出后分块切除实体肿瘤部分。结果36例全切除；1例次全切除，侧脑室钙化囊壁残留，长期无特殊变化：1例鞍内、2例鞍旁残留均加行放射治疗。术后早期26例出现尿崩，33例出现不同程度钠、氯、钾、镁、钙等电解质紊乱，2例出现高热及术后早期意识恢复不佳．6例视力下降加重，均经积极治疗后好转。36例术后不同时间参加日常工作，2例需要生活照顾，2例死亡。结论 术前良好准备，精心设计手术入路，保证良好视野和照明，术中直视下尽可能多锐性解剖，保护垂体柄、下丘脑及其小的穿支血管，术后立即监测水电解质的变化对防治大型颅咽管瘤术后并发症具有重要价值。     

经额底纵裂入路切除颅咽管瘤(附83例分析)

目的探讨经额底纵裂入路切除颅咽管瘤的手术方法和疗效。方法回顾性分析83例经额底纵裂入路手术的颅咽管瘤病人的临床资料。其中复发性颅咽管瘤33例。术中行双额冠状切口,右额开颅,牵开额底纵裂,暴露鞍结节-胼胝体膝部区域,根据肿瘤位置可经终板、视交叉-前交通动脉间隙及视交叉前间隙切除肿瘤。结果肿瘤全切除81例(97.6%);保留垂体柄58例(69.9%),未见垂体柄2例(2.4%),因肿瘤已完全侵蚀垂体柄,将其与肿瘤组织一并切除23例(27.7%)。视力改善68例,未改善15例。术后并发症主要为多饮多尿81例,电解质紊乱79例。结论经额底纵裂入路是治疗颅咽管瘤安全有效的方法。     

颅咽管瘤的显微手术治疗及随访

目的探讨翼点入路为基础的颅咽管瘤全切除方法，并通过长期随访了解患者生存状态。方法根据肿瘤影像学表现的生长部位及扩展方向将翼点入路进行改良，对121例颅咽管瘤患者进行手术治疗，并对其中83例进行12-84个月的随访。结果本组全切除、近全切率分别为79．3％、19．0％，术后最常见的肿瘤残留部位位于肿瘤与第三脑室底部前端连续处。术后最常见的下丘脑反应为尿崩症（86、8％）及低钠、高钠血症（68、6％），其中高钠血症预示严重的下丘脑反应，但经过处理术后反应多可良好控制。围手术期死亡3例（2．5％）。11例随访期内复发，复发率13％。随访期患者复发最常见于术后2年内。结论根据肿瘤生长方向及大小，选择各种改良翼点入路进行积极的全切除，多数颅咽管瘤可以得到良好的长期控制和生存质量。     

前纵裂人路显微手术切除颅咽管瘤

目的探讨前纵裂人路显微手术切除颅咽管瘤的方法和治疗效果。方法回顾性分析43例经前纵裂人路手术的颅咽管瘤病人的临床资料,其中复发颅咽管瘤2例。分析其术前评估、手术技巧和术后处理。结果肿瘤全切除30例,次全切除13例。垂体柄保留37例,切除6例。术后视力恢复或好转32例,无明显变化2例。术后并发症：多饮多尿9例,其中一过性尿崩症5例;电解质紊乱6例;颅内感染1例。本组无脑脊液漏及死亡病例。32例随访6。24个月,无肿瘤复发。结论经前纵裂人路能很好暴露手术视野,对脑组织损伤小,是手术切除中线生长的颅咽管瘤安全、有效的手术人路。但术前全面评估选择合适的手术入路也至关重要。     

经眶额颞-终板入路显微手术切除视交叉后部病变

目的报告23例视交叉后部病变的手术治疗经验，探讨视交叉后部病变的手术入路和显微手术技巧。方法采用眶额颞-终板入路显微切除视交叉后占位性病变23例，其中颅咽管瘤13例，垂体腺瘤4例，术前诊断未明者6例。结果16例病灶全切除，5例次全切，2例部分切除。15例术中解剖保留垂体柄。术后并发一过性尿崩17例，永久性尿崩1例，视力障碍加重2例。术后15例随访16—48个月，8例随访3-12个月，其中2例复发。结论经眶额颞-终板入路对于视交叉后部病变可提供足够的操作空间，术中显微解剖鞍区各脑池，妥善保护好颅底前循环及其重要穿通支、视通路、垂体柄和下丘脑等，术后可取得良好的临床疗效。     

Radical resection of craniopharyngioma

Introduction The best management of craniopharyngioma in children remains a controversial topic among neurosurgeons. The two treatments for craniopharyngioma most commonly discussed in the literature are primary total resection and limited resection followed by radiotherapy. Without ignoring the challenging behavior of these tumors, we strongly believe that the first approach in a child with a craniopharyngioma is to attempt total removal. Trying to remove a craniopharyngioma that has been treated previously with other methods is, in our experience, much more dangerous because of adherences of the tumor to vascular and neural structures.Material and methods Between 1988 and 2004, we operated on 153 patients with craniapharyngioma (40% female and 60% male), whose ages at the time of surgery ranged from 15 days to 21 years (mean 10.5 years). Eighty-seven percent of the patients were found to have some visual disturbance and 42% endocrinological alterations. Fifty-four percent of the patients presented hydrocephalus, but only 18% had shunting. Gross total removal was attempted in all patients. Among the 153 patients, the tumor was prechiasmatic in 35 and retrochiasmatic in 112; in ten, these were considered giant forms, and eight had a posterior fossa extension. We performed 84 single and 69 combined approaches.Results We achieved total removal in 69% of our patients. None of our patients regarded as having undergone total tumor resection disclosed recurrence after a follow-up of 1–16 years. Radiation therapy was administered in children with subtotal removal. All children underwent total removal, but only 62% of those who underwent subtotal removal had good outcomes. After surgery, endocrinological status worsened in almost all patients, but visual status improved markedly.Conclusions The treatment of choice in craniopharyngioma in childhood is total resection in order to avoid radiation therapy and recurrence. When total resection is not possible, subtotal resection plus radiation therapy is the alternative.     

颅咽管瘤经蝶显微手术治疗

目的:经蝶显微手术切除颅咽管瘤,适用起源于鞍底的肿物或向鞍上扩展者。作者回顾性总结了18例颅咽管瘤的诊断方式、手术技巧和治疗结果。方法:本组均经计算机体层摄影(CT)或磁共振成像(MRI)扫描确诊。手术采取经唇下—鼻中隔—蝶窦入路或经鼻前庭-鼻中隔—蝶窦入路两种方式行肿瘤切除术。结果:9例肿瘤获全切除,4例次全切除,其余5例为部分切除,无术后死亡。15例获长期随访(平均随访期为3年1个月),有12例(80％)恢复良好,3例影像学检查提示肿瘤复发,需行再次手术、放疗或放射外科治疗。结论:对颅咽管瘤选择合适病例经蝶入路显微手术切除,是一种安全、有效的方法。     

Removal of tumors in the III ventricle using the lamina terminalis approach

Tumors in the III ventricle were totally removed in three children using a route through the lamina terminalis. The cases are discussed on the basis of computed tomography and intraoperative findings. It seems that tumors 4×2 cm in size can be successfully removed via this relatively small opening if the neuroradiological findings and the probable histology (craniopharyngioma) provide secure evidence that the tumor site and growth matrix are located in the frontal and lower portion of the III ventricle. Besides the advantage of requiring no transparenchymal access, this quick axial (orthograde) approach exerts no pressure on the hypothalamus, a complication which cannot always be avoided with the transcallosal route or the route through the foramen of Monro. Furthermore, the immediate location of the tumor behind the usually protruding lamina terminalis permits a rapid operation without exploratory characteristics. The distance between the brain surface and the tumor with this procedure is 0 cm; however, it can be up to 9 cm, depending on the age of the patient, with other approaches.Presented at the 11th Meeting of the European Society for Paediatric Neurosurgery, Naples 1988     

Impact of maximal safe resection on the clinical outcome of adults with craniopharyngiomas

Recent studies suggest that subtotal resection (STR) followed by adjuvant radiation therapy is an appealing alternative to gross total resection (GTR) for craniopharyngioma, as STR provides similar tumor control without the associated endocrinological and behavioral morbidity. We have examined the impact of maximal safe resection on the clinical outcome of patients with craniopharyngioma. A total of 90 patients underwent surgical resection of craniopharyngioma at a single institution between January 1995 and April 2009. Sixty-one patients underwent GTR alone, four underwent GTR followed by adjuvant radiotherapy, 15 underwent STR alone, and 10 underwent partial removal followed by adjuvant radiotherapy. We analyzed and compared the clinical and endocrinological outcomes and radiological follow-up data of these patients. During the follow-up period, tumor recurrence following the initial resection occurred in 36 of 90 patients (40%). The repeat resection rate was higher in the STR group than the GTR group. Recurrence occurred in 20 of 61 patients (32.8%) from the GTR alone group, in 11 of 15 patients (73.3%) from the STR alone group, and in five of 10 (50%) patients from the STR with adjuvant radiation, such as radiotherapy or stereotactic radiosurgery, group (p=0.030). Maximal safe resection of craniopharyngioma leads to excellent local control. STR with adjuvant radiation therapy does not assure preservation of endocrine function, although it provides better local control than STR alone.