枕部经小脑幕入路切除松果体区肿瘤

作者采用枕部经小脑幕入路对24例松果体区肿瘤进行了手术切除,其中全切除11例;次全切除9例;部分切除4例.24例中.21例症状改善,2例恶化,1例死亡.作者认为,此入路的优点有:①深静脉系统保持在直视下,不易损伤;②供应肿瘤的动脉分支可以早期得以控制;③视野开阔,尤其适用于肿瘤较大.向侧方和(或)脑室内生长者;④可同时进行侧脑率-脑池的分流手术.根据我们的经验.术前伴有脑积水的松果体区肿瘤不论肿瘤是良性还是恶性.也不管肿瘤是否全切除,中脑导水管在术后短期内似乎都不能再通.因此我们认为,对这些病人在切除(即使是全切除)肿瘤后都应同期或分期作分流手术.

Occipital transtentorial approach for resection of pineal region tumors

Twenty four patients with pineal region tumors were operated upon via occipital transtentorial approach. Among them, the tu-mors were totally removed in 11 cases jsubtotally in 9; partially in 4. The neurological condition improved in 21 cases, whereas deteriorated in 2 and only 1 died after surgery. The advantages of this approach were as follows:(1)the deep venous system was kept under direct vision; (2)early control of vascular supply was easily accomplished; (3)good visualization,particularly for exposure of ventricular and lateral extension of the tumors,-(4) a lateral ventricular-cistern shunting could easily be placed just following excision of the tumor. According to our experience, the aqueduct did not reopen during a few days in the postoperative period. The patients with pineal region tumor, usually had hydrocephalus preoperatively, despite the tumor was benign or malignant, and the tumor was totally removed or not,and therefore most of the patients should undergo placement of a shunt system.