经额下纵裂入路显微手术切除颅咽管瘤的研究

目的探讨经额下纵裂入路显微手术切除较大颅咽管瘤的手术要点及效果。并与其他入路比较,观察患者的术后恢复情况。方法采用额下纵裂入路切除较大颅咽管瘤22例;采用翼点入路切除稍小颅咽管瘤16例。两组患者术前和术后采取积极措施防治出入量失衡及电解质紊乱,比较两组患者的预后。结果 22例采用额下纵裂入路患者的颅咽管瘤均全切除,手术效果好。术后2周内,患者出入量失衡及电解质紊乱情况较翼点入路切除肿瘤的患者明显轻微。术后随访1年,其中3例患者口服抗利尿药物至术后3个月,尿量恢复正常并停药;1例患者1年后皮质醇仍低于正常,继续给予糖皮质激素替代治疗。结论颅内较大颅咽管瘤对脑正常解剖结构产生严重挤压,肿瘤与下丘脑、垂体柄等结构粘连紧密;采用额下纵裂入路可做到在显微镜直视下分离粘连部位,达到肿瘤全切除,比其他入路有较明显的优点;且术后水电失衡明显轻微,患者恢复情况满意。

Study on microsur gery for craniopharyngioma through subfrontal combined interhemispheric approach

Objective To investigate the effects of microsurgery for larger craniopharyngioma through the subfrontal combined interhemispheric approach and compare it with other approaches by surveying the recovery of patients after operation .Methods 22 cases of larger craniopharyngioma patients were operated on with the subfrontal combined interhemispheric approach andprevented from internal environment disorder by carefully taking active measures .Results 22 cases of craniopharyngioma had total resection , which had a better prognoses with the subfrontal combined interhemispheric approach .Within postoperative 2 weeks, the disturbance of electrolyte and fluid balance were even more mild compared with pterional approach .All patients'daily life were not affected after followed up for 2 years.But 3patients were treated with oral antidiuretic drugs until urine volume returned to normal after 3 months .The cortisol levels of 1 patients was still below average and hormone replacement therapy was continue taken .Conclusions Intracranial large craniopharyngioma has a severe extrusion to normal anatomy such as the hypothalamus , the stalk hypophysial .Craniopharyngioma could gain satisfactory resection with sufficient field of vision under surgical-microscope with the subfrontal combined interhemispheric approach , because the micro-structure between tumor and normal structure was completely showed .