松果体区肿瘤的显微手术及内镜辅助作用

目的 探讨显微手术治疗松果体区肿瘤的手术入路和技术以及内镜的辅助作用.方法 采用显微手术技术通过幕下小脑上入路切除10例松果体区肿瘤,其中内镜辅助手术5例;病理结果：生殖细胞瘤5例、混合性生殖细胞肿瘤3例（生殖细胞瘤合并恶性畸胎瘤1例,合并胚胎癌2例）、脑膜瘤和成熟畸胎瘤各1例;1例术后脑积水行第三脑室底造瘘术,1例术前行第三脑室底造瘘.结果 所有病例全切肿瘤.术后早期结果全部良好,随访1个月～7年良好8例,死亡2例.结论 松果体区肿瘤手术难度较大,但选择适合的手术入路和熟练的显微手术技术加上内镜的辅助可以取得满意的疗效.

Endoscopy-assisted microsurgery for the management of pineal region tumors

Objective To discuss the approaches, techniques and the role of endoscopy for patients with pineal region neoplasms. Methods 10 patients with pineal region tumors underwent operations by infratentorial supracerebellar approach for resecting the neoplasms. Among them, endoscopy-assisted microsurgery was used in 5 patients. Pathological diagnosis showed germinoma in 5 cases, mixed germ cell tumor in 3 （germinoma mixed with malignant teratoma in 1 case and with embryonal carcinoma in 2 ）, meningoma in 1 and mature teratoma in 1. Endoscopic third ventriculostomy was carried out in 1 case preoperatively and 1 case postoperatively due to hydrocephalus. Results Complete resection were achieved in all cases. All patients had good early results. Follow-up studies were performed from 1 month to 7 years after operations. 8 patients were in good condition and 2 died. Conclusions Resection for the pineal region tumors is very difficult, but suitable surgical approach with meticulous microsurgical procedure assisted by endoscopy may provide favorable prognosis.