神经内镜治疗导水管梗阻性脑积水12例临床经验

目的 总结神经内镜下手术治疗12例导水管水平梗阻性脑积水的初步体会。方法 12例脑积水患者中导水管水平阻塞为原发性10例,继发于顶盖区肿瘤者2例。均采用神经内镜经侧脑室额角入路,经室间孔行三脑室底脚间池造瘘。结果 12例患者造瘘术过程顺利,术中术后并发症少而轻,12例中术后3个月已随访的患者9例,7例有效,2例无效。结论 神经内镜是治疗导水管梗阻性脑积水的有效手段,近期疗效满意。术中应针对三脑室底不同的特点采用适当的造瘘方法,随访应以确定颅内压是否正常、症状是否消失作为判断疗效的主要依据。     

听神经瘤安全切除及术中面神经保护解剖学基础

目的　探讨听神经瘤的安全切除、术中面神经保护技术及解剖学基础。 方法　121例听神经瘤全部采用枕下乙状窦后入路, 在显微外科基础上采用神经电生理监测技术,配合超声吸引（CUSA）和激光刀切除肿瘤, 术后采用House-Brackmann (HB)分级方法对面神经功能进行评价。 结果　肿瘤全切除100% (121例)。面神经解剖保留93.4% (113例),蜗神经解剖保留90.1%（109例）,无死亡病例。术后3 个月回访121例,按House-Brackmann 分级对面神经功能评估,I-II级71.9% (87 例),III-IV级25.6% (31例),V-VI 级3.3% (4例)。 结论 掌握听神经瘤与蛛网膜关系的解剖学基础是听神经瘤安全切除及面神经功能保护的关键。     

132例松果体区肿瘤的临床研究

Objective To review the clinical manifestations, imaging, tumor markers, treatment methods, pathology results and clinical curative effects of pineal region tumors and to evaluate the characteristics and intervention strategies for those tumors. Methods The clinicopathological data of 132 patients with pineal region tumor treated in our department between January 2000 and May 2008 were retrospectively studied.Results A moderate predominance in males was presented. The clinical manifestations of the disease included increased intracranial pressure and ocular movement impairment. There were some features but no regularity and specific appearance on imaging including CT and MRI. 88. 6% of patients associated with hydrocephalus. A high serum level of alpha-fetoprotein (AFP) was presented in 14 cases and high HCG in 9 cases.Eighteen cases received direct radiation therapy and 7 had radiotherapy post biopsy. 107 cases were treated surgically and 63 cases received postoperative adjuvant treatment. 114 cases had pathology results including 56 germ cell tumors. The patients were followed up for 12 ～ 132 months. Recurrence developed in 23 cases and 12 cases died.The 5-year survival rate was 89. 3%. Conclusion Pineal region tumors are often associated with hydrocephalus and this makes preoperative diagnosis difficult. Imaging examination may help diagnosis but less specific. Germ cell tumors may diagnosed by some tumor markers. Radiation therapy is the choice of treatment for pure germinomas.Other types of pineal region tumors should receive surgical treatment. Postoperative adjuvant treatment based on pathology can provide a good prognosis in pineal region tumor.     

原发性松果体区绒毛膜癌的综合治疗(附2例报告)

目的 原发性松果体区绒毛膜癌罕见,本文报道2例,探讨其诊断、治疗和预后.方法 2例经病理证实的原发性松果体区绒毛膜癌,术前均有血清人绒毛膜促性腺激素(HCG)显著升高,分别为128 935.7mIU/ml和9088.9mIU/ml,甲胎蛋白均为阴性.采用显微手术全切肿瘤,神经内镜下三脑室底造瘘术治疗术后脑积水.2例患者术后均联合化疗及放疗.结果 2例患者肿瘤均全切除,脑积水缓解.经辅助治疗后血清HCG水平降至正常,术后两年磁共振检查无复发,血清HCG检查1例正常,另1例略高于正常.结论 HCG检测对绒毛膜癌的诊断和治疗后监测非常重要,该病治疗应采用积极的手术全切除和术后综合治疗手段,可获得理想的疗效.     

神经内镜手术治疗颅内蛛网膜囊肿

目的 探讨神经内镜手术治疗颅内蛛网膜囊肿的手术指征、手术方法和预后。方法 回顾性分析26例采用神经内镜手术治疗的颅内蛛网膜囊肿，其中采用神经内镜下囊肿脑池造瘘和囊壁部分剥除18例，囊肿次全切除3例，囊肿脑室造瘘5例(1例尚行脑室腹腔分流术)。术后随访3个月-2年。结果 术前有症状的20例患者中，症状消失11例，改善7例，无变化2例，术后不能改善的症状主要是癫痫。有随访影像学复查结果的16例患者中，囊肿消失6例，缩小7例，无变化3例。结论 神经内镜手术是治疗颅内蛛网膜囊肿有效和微创的方法。     

颅内表皮样囊肿和成熟畸胎瘤破裂五例

目的 总结颅内表皮样囊肿和畸胎瘤破裂的临床特点和治疗结果.方法 回顾分析5例颅内表皮样囊肿和成熟畸胎瘤破裂患者的临床表现、影像学特点、治疗方法和预后.结果 5例患者病变均位于蝶鞍区,1例为外伤导致破裂,4例为自发破裂,主要症状是头痛和癫痫,影像学上可见特征性的脂性溢出物,表现为蛛网膜下腔和脑室内的T1高信号颗粒,在脂肪抑制序列呈低信号,手术后症状均消失.结论 颅内表皮样囊肿和畸胎瘤破裂具有特殊的影像学表现,磁共振成像的T1加权像和脂肪抑制成像对诊断最有价值,手术治疗可切除病变、缓解症状,预后良好.     

颅咽管瘤侵袭第三脑室的方式对手术切除的影响

Objective To assess the impact of the positional relationship between the large craniopharyngiomas and the third ventricle on the outcome of surgical resection of the tumors. Methods In 72 cases of craniopharyngiomas, the tumors were classified into two types according to the radiographic and surgical findings defining the relationship between the tumors and the third ventricle. For each type of tumors, 3 grades were classified based on the tumor size, texture, and infiltration pattern of the third ventricle. The extend of tumor removal was confirmed by both intraoperative evaluation and postoperative CT or magnetic resonance imaging. The correlation between the degree of hypothalamus invasion and the extend of tumor removal was analyzed in all the cases. Results The craniopharyngiomas were classified into two types, namely those residing in the third ventricle (7 cases) and those invading the third ventricle(65 cases). The degree of tumor resection was significantly different between the 3 grades: total tumor removal was achieved in 95.7% of grade Ⅰ cases, in 80.0% of grade Ⅱ cases, and in only 47.4% of grade Ⅲ I cases (P<0.05). conclusion Understanding of the anatomical relationship of the tumor to the third ventricular floor can be great value for improving the outcome of surgical resection of large craniopharyngiomas.     

神经内镜手术治疗症状性透明隔囊肿（附10例报告）

目的探讨症状性透明隔囊肿的诊断、手术指征选择、神经内镜手术方法和预后。方法10例症状性透明隔囊肿患者，以间断性发作的颅高压症状和癫痫为主要临床表现，囊肿最大宽度12-35 mm，行神经内镜下透明隔囊肿侧脑室造瘘术。结果随访3～17个月，8例患者术后症状完全消失，2例患者症状显著改善。结论神经内镜下透明隔囊肿侧脑室造瘘术是治疗有症状性透明隔囊肿的最有效方法之一，手术操作时应注意副损伤。     

神经内镜治疗脑积水术后颅内感染的相关因素

目的研究神经内镜治疗脑积水术后颅内感染的相关因素及防治方法。方法研究经神经内镜治疗后脑积水术后感染及可疑感染病例52例,分析可能和术后颅内感染相关的因素及防治方法。结果器械的消毒方法、手术操作时间、术后脑脊液漏、脑室内或蛛网膜下腔出血、脉络丛烧灼及全身感染可能是相关因素,而脑脊液白细胞数并不是颅内感染的决定因素。结论重视脑积水围手术期的处理是提高手术成功率、降低术后并发症的重要措施。     

神经内镜在治疗伴发于胼胝体发育不良的顷内囊肿中的应用

目的探讨神经内镜在胼胝体发育不良（ACC）伴发颅内囊肿治疗中的诊断和治疗作用。方法对2例利用神经内镜冶疗的伴发于胼胝体发育不全的颅内囊肿的影像学和手术资料进行分析，2例胼胝体完全缺如伴幕上巨大囊肿的患儿，1例行神经内镜下囊肿内探查联合囊肿腹腔分流术，另1例行神经内镜下囊肿造瘘术。结果2例患儿手术均取得成功，术后囊肿显著缩小，患儿运动功能发育虽滞后，但仍可稳步发育。结论胼胝体发育不良伴颅内囊肿的患儿，单凭影像学难以判定囊肿是否与脑室系统交通，借助神经内镜可直观的观察囊肿与脑室系统的交通情况，可据此选择合理的手术方式。