囊性颅咽管瘤的CT诊断及鉴别诊断

颅咽管瘤是鞍上区常见肿瘤 ,一般认为是一种胚胎残余组织肿瘤 ,其表现典型 ,较容易诊断。本文收集囊性颅咽管瘤 2 5例 ,对其诊断及鉴别诊断进行了分析讨论。1　临床资料1 1　一般资料本组 2 5例 ,男性 2 0例 ,女性 5例 ,年龄为 15～ 5 5岁。其中 18例有头痛 ,15例有视力下降 ,10例有恶心、呕吐 ,1例有肢体活动障碍。1 2　方法采用美国ＧＥ160 0ｉ全身ＣＴ机扫描 ,矩阵 5 12× 5 12 ,层厚 10ｍｍ ,层距 10ｍｍ全部病例均做平扫及增强扫描。1 3　ＣＴ表现1 3 1　位置及形态 :18例位于鞍上 ,7例大部分瘤体位于鞍上 ,少部分位于鞍内。 18例鞍上…     

颅咽管瘤92例手术治疗

１９８７～１９９７年，本科共治疗颅咽管瘤９２例，现报道如下。１临床资料１１一般资料９２例患者中男性５４例，女性３８例，年龄４～６３岁，平均年龄２４６岁。其中９岁以下２０例，１０～１９岁３６例，３０～３９岁１４例，４０～４９岁１３例，５０～５９岁７...     

囊性颅咽管瘤内照射治疗进展

<正> 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病死率。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入胶体~(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(Internl irradiation for cystic cranio-pharyngioma,IICC)情况作一综述。     

颅咽管瘤的临床特点

目的了解颅咽管瘤的临床特点。方法作者收集了国内1999年～2004年9月五年间。在51种省级以上杂志发表的80篇有关颅咽管瘤的文章，所报道颅咽管瘤病例共3601例，来自全国21个省，直辖市，自治区的50家医院。根据如下条件进行病例选择：1经手术，病理证实为颅咽管瘤，2依照文章的作者。所报道病例的来源医院以及住院时间剔除重复病例，最后得到59篇文章的59组病例，共2837人，作者对其描述的颅咽管瘤的临床特点进行了统计分析。结果颅咽管瘤的年龄特点是发病不受年龄限制，年轻人稍微偏多。颅咽管瘤的性别特点是男多于女，男女人数比为1．4：1。颅咽管瘤肿块的特点是容易囊变，影像学平均囊变率为83．5％，实际囊变率更高；容易钙化，影像学平均钙化率为58．3％。实际钙化率更高；肿块的位置，按照yasargil的分类，最常见的是鞍上-视交叉旁-脑室外型，占一半以上。其次是鞍内-鞍上型和脑室旁型。其余三型。相对偏少。结论用统计学的方法对颅咽管瘤的临床特点进行量化分析。有利于更深刻地了解颅咽管瘤。     

囊性颅咽管瘤的内放射治疗

目的：探讨囊性颅咽管瘤的最佳治疗方法。方法：３０例采用立体定向穿刺囊内置管术；２０例手术部分切除＋囊内置管术。每人治疗２～３次，间隔时间一个月，每次按每克肿瘤组织给以０１５～０２ｍＣｉ放射剂量，平均２４８ｍＣｉ／次。结果：手术成功率１００％。平均随访３５年，近期有效率１００％，远期有效率９０％。２例肿瘤复发需手术治疗，其余均恢复工作或学习能力。结论：颅咽管瘤系良性肿瘤，内放射治疗可收到良好的治疗效果。     

立体定向间质内放疗法治疗囊性颅咽管瘤20例临床分析

颅咽管瘤常呈囊性变且进行性扩大，手术全切除较为困难，且常有生命危险，易于复发。肿瘤间质内照射方法简便易行，对病人损伤小，可根治肿瘤并减少囊液分泌［1］。我们采用CT引导RADIONIC立体定向仪，通过颅咽管瘤囊内置onunsya贮液泵，定期注人”P的方法治疗20例囊性颅咽管瘤患者，取得了较满意的疗效，现报告如下。临床资料与方法1临床资料本组20例，男12例，女8例，年龄7－76岁。全部病例均经CT或病理检查证实，其中开颅术后复发5冽，未经手术治疗15例。20例颅咽管瘤均有囊性变。主要临床表现：单眼完全失明3例，眼前仅存指动或部…     

26例儿童囊性颅咽管瘤的立体定向内放疗

目的 研究ＣＴ立体定向囊腔内放疗治疗儿童囊性颅咽管瘤的有效性和安全性。方法 对２６例囊性颅咽管瘤进行ＣＴ立体定向囊腔、胶体磷酸铬内治疗。结果 全部病例经手术排除囊液后临床症状迅速改善,经囊腔内放疗,１～５年随访。ＣＴ扫描显示２２例（８４．６％）瘤腔持续消失,２例（７．７％）瘤腔显著缩小,症状持续改善。２例（７．７％）分别于１、３年后因瘤实质部分增大,症状恶化而相继死亡。无手术死亡和严重并发症。结论 ＣＴ立体定向囊腔内放疗治疗儿童囊性颅咽管瘤安全、有效,可作为治疗儿童囊性颅咽管瘤首选的方法。     

经胼胝体-透明隔-穹窿间入路切除三脑室内颅咽管瘤

目的：探讨经胼胝体-透明隔-穹窿间入路切除三脑室内颅咽管瘤的疗效和并发症。方法：回顾性分析28例经胼胝体-透明隔-穹窿间入路切除的三脑室内颅咽管瘤患者的病例资料。结果：肿瘤全切18例,次全切6例,部分切除4例。术后主要并发症为电解质紊乱、尿崩症、内分泌功能紊乱、缄默、体温调节障碍、癫痫等。结论：经胼胝体-透明隔-穹窿间入路为切除三脑室内颅咽管瘤最佳入路之一;颅咽管瘤术后并发症多且严重,充分的术前准备及良好的围手术管理是手术成功的前提。     

应用神经内镜行三脑室底造瘘术治疗梗阻性脑积水

目的探讨应用神经内镜行三脑室底造瘘在治疗梗阻性脑积水中手术方法、效果和影响手术效果的因素、手术后并发症的的预防。方法回顾性分析55例行神经内镜治疗梗阻性脑积水的临床资料。结果55例患者中54例造瘘成功,1例因三脑室底布满血管网不能造瘘,50例效果良好,4例患者无效,于造瘘后3个月内又行脑室腹腔分流术。手术后发生硬膜下积液8例,1例患者4个月后发生慢性硬膜下血肿又行钻孔外引流术。头皮下积液8例,手术后发热15例。癫痫1例,硬膜外出血1例。结论神经内镜行三脑室底造瘘是安全有效的,效果满意。     

Microsurgical resection of craniopharyngioma of the third ventricle via an improved transventricular approach

Background Craniopharyngioma of the third ventricle is difficult to treat and its therapeutic regimens and operative approaches have been controversial. This study was undertaken to probe indications for microsurgical resection of craniopharyngioma of the third ventricle via an improved transventricular approach, its surgical procedures and therapeutic effects, and prevention of postoperative complications. Methods Fifty-one patients with craniopharyngioma of the third ventricle were treated from January 2000 to October 2004 by an improved transventricular approach for removing the tumor viathe interventricular foramen, the intermedius of the septum pellucidum or choroid fissure. Symptoms and signs of the patients, and results of imaging, operation, and follow-up were analyzed. Results Of the 51 patients who had received the improved transventricular resection, 4 underwent a combined approach with an entrance of the pterion. Forty patients (78.43%) underwent total resection and others subtotal resection, without an operative death. Epileptic seizures were found in 3 patients (5.88%) and subdural effusion in the operative field in 4 (7.84%). All patients showed good general conditions after operation, and follow-up for an average of 27.52 months showed relapse of the tumour in 8 patients (15.69%). Conclusions Microsurgical resection of craniopharyngioma of the third ventricle by an improved transventricular approach has advantages of operative safety and efficacy, lower mortality and disability, and less complications.     

影响颅咽管瘤术后尿崩的因素分析

目的 探讨颅咽管瘤术后尿崩的影响因素,以及术后尿崩的处理.方法 回顾性分析121例经手术治疗的颅咽管瘤术后尿崩情况,并分析影响尿崩的因素.结果 术前尿崩发生率为27.3% (33/121例),术后早期尿崩率89.9%(107/119例),晚期尿崩率为39.8%(37/93例).早期尿崩与肿瘤分型、肿瘤钙化程度显著相关,鞍膈上脑室外型肿瘤术后发生早期尿崩率最低.远期尿崩与年龄、术中垂体柄的处理、肿瘤分型显著相关,与肿瘤切除程度、肿瘤钙化程度无显著相关.非成人组较成人组发生远期尿崩率高,垂体柄离断者较垂体柄保留者发生远期尿崩率高,鞍膈上脑室内外型较鞍膈上脑室外型、鞍膈下型发生远期尿崩率高.结论 颅咽管瘤术后尿崩与肿瘤分型、肿瘤钙化程度、垂体柄的保护程度等多种因素相关.     

内镜下脑积水的手术治疗(附32例报告)

目的 评价神经内镜对脑积水的治疗作用。方法 回顾性分析内镜下行不同治疗方式的32例不同类型脑积水患者的临床资料。结果 随访3月～2年，9例梗阻性脑积水采用内镜下脑室造瘘术(7例行三脑室底造瘘术即ETV，2例行透明隔造瘘)，8例治疗有效，1例ETV后脑积水无明显改善，改行脑室腹腔分流术(V-P分流)；23例交通性脑积水采用内镜下引导V-P分流(10例)或内镜下引导V-P分流加内镜下脑室造瘘术(12例行ETV，1例行透明隔造瘘)，脑积水均获得改善。结论 梗阻性脑积水采用神经内镜脑室造瘘术，交通性脑积水采用内镜引导V-P分流或内镜引导V-P分流加脑室造瘘术，均可获得满意疗效。     

半导体激光配合神经内窥镜治疗脑积水和颅内囊肿

目的探讨半导体激光配合神经内窥镜在手术治疗脑积水和脑内囊肿(液态,良性)中的应用价值。方法采用半导体激光配合神经内窥镜手术,选择适当的输出功率,凝固止血时采用功率5～12 W,气化切割时采用功率15～30 W,进行凝固、止血、气化、切割等手术治疗脑积水和颅内囊肿。随访时间术后6个月至2 a,均经头部CT或MR I复查。结果64例中颅内囊肿16例无复发;脑积水48例,其中46例症状明显得到改善,2例无效者改用内窥镜辅助下脑室-腹腔分流术后症状改善。术后并发硬膜下血肿1例,脑室少量出血5例,均经保守治疗痊愈,无感染等其他并发症,总有效率达96.8%。结论半导体激光配合内窥镜技术治疗脑积水、颅内囊肿创伤小,安全性高,术后并发症少,疗效确切。     

Microsurgical treatment of craniopharyngiomas: report of 284 patients

Background Generally, total surgical removal of craniopharyngioma results in satisfactory outcome with a low recurrence rate, however, the location of the tumor and its adherence to the hypothalamic structures can make the operation difficult. The goal of the present study was to assess the outcome of craniopharyngiomas in 284 patients treated surgically.Methods A total of 284 patients (151 men and 133 women) with craniopharyngioma were treated surgically by our neurosurgeons from January 1996 to March 2006. Among them, 226 (79.6%) patients were adults (15 years of age or older; mean, 35.8±10.6), 58 (20.4%) were children (14 years of age or younger; mean, 9.1±3.8). The diameter of the tumors were 2.0－9.0 cm (mean, 36.54±11.4). The tumors were classified into the superior (23 patients) and inferior ventricular (261) types according to the location of the tumor relative to the third ventricular floor. For the patients with craniopharyngioma of inferior ventricular type, pterional approach was used in 191 (67.3%) patients, subfrontal approach in 17 (6.0%), and translamina terminalis through frontobasal interhemispheric approach in 53 (18.7%). For those with the tumors of superior ventricular type, transcallosal approach into the anterior third ventricle was done in 10 (3.5%) patients, and the lamina terminalis approach in 13 (4.6%). Of the 284 patients, 204 (71.8%) were followed up for 0.5 to 8 years (mean, 2.1±1.8), including 162 patients received total tumor removal, and 37 underwent subtotal or partial removal. Results Total, subtotal and partial removal of the tumors were achieved in 237 (83.5%), 34 (12.0%) and 13 (4.5%) patients, respectively. The pituitary stalk was preserved in 176 (62.0%) patients, severed in 52 (18.3%), and unidentified in 56 (19.7%). Twelve (4.2%) patients died within one month after the surgery. During the follow-up, 23 (14.1%) patients experienced tumor recurrence 1.0－3.5 years (mean, 1.8±1.6) after total tumor removal, and 24 (64.9%) had recurrent tumor 0.25－1.5 years (mean, 0.5±0.4) after subtotal or partial resection. Normal activities of daily living were regained in 63 (80%) patients, independence in 29 (14.2%), and daily life with assistance in 9 (4.4%). Four (2.0%) patients died 0.9－3 years (mean, 1.6±1.4) after discharge from hospital, 3 of them died of hypothalamic deficiency. Conclusions We can protect the hypothalamic structures and its perforating arteries by choosing surgical approaches according to the location of craniopharygioma relative to the third ventricular floor. The mortality, morbidity, and recurrence rate in patients received total resection are lower than those of patients underwent subtotal or partial resections. In addition, preservation of the pituitary stalk is critical when total tumor resection is feasible.     

显微手术结合伽玛刀治疗颅咽管瘤的临床分析

目的评估显微手术结合伽玛刀治疗颅咽管瘤的临床效果.方法 31例颅咽管瘤行显微手术次全切除术后,辅以伽玛刀治疗.结果 28例获10个月到7年随访(平均4年),肿瘤控制率达92.8%(26/28);2例分别在术后第3年及第5年复发,经再次显微手术结合伽玛刀治疗后,随访至今无复发,无1例死亡.结论显微手术结合伽玛刀治疗颅咽管瘤是安全有效的,对于术后复发病例可再次治疗.     

博来霉素与卡氮芥体外抑制颅咽管瘤的比较

目的 :比较卡氮芥与博来霉素对颅咽管瘤细胞的体外抑瘤效果。 方法 :体外原代培养新鲜颅咽管瘤细胞 ,然后分别加入浓度为 0 .0 1、0 .1和 1.0 g/L的博来霉素或卡氮芥培养液进行培养 ,在不同时段计数以绘出抑瘤曲线 ,培养 6 d后以 ATP荧光测定法测定抑瘤效果。结果 :加药后肿瘤细胞明显减少 ;0 .0 1、0 .1和 1.0 g/L的博来霉素和卡氮芥的相对 ATP含量 (×10 - 1 4 mol/L)分别为 30 5 .5 8± 6 1.11、16 4.5 0± 5 3.0 3、1.14± 0 .45和 1.0 1± 0 .82、0 .6 8± 0 .19、0 .0 4± 0 .0 3,同一浓度组中卡氮芥抑瘤效果强于博来霉素。较低浓度组博来霉素无显著抑制颅咽管瘤作用 ,而不同浓度组卡氮芥均有显著抑瘤作用。 结论 :卡氮芥体外抑制颅咽管瘤的效果强于博来霉素 ,有应用于颅咽管瘤囊内化疗的潜在价值。     

Image-guided extended endoscopic endonasal transsphenoidal approach for removal of craniopharyngiomas in the suprasellar region and the third ventricle

<正>Objective Intracranial hemangiopericytomas (HPCs) were rare neoplasms with relatively high rates of recurrence and extracranial metastasis.The differential diagnoses from angiomatous meningiomas and solitary fibrous tumors(SFTs) are very important. This study aimes to reveal differences in the specific immunohistochemical features of HPCs,angiomatous meningiomas and SFTs by newly developed