经胼胝体-透明隔-穹窿间入路的临床应用

目的探讨经胼胝体-透明隔-穹窿间入路显微手术切除三脑室内肿瘤的手术适应证、优缺点，并对相应的显微解剖要点和术后并发症的处理进行讨论。 方法回顾性分析2004年9月至2017年8月期间陆军总医院附属八一脑科医院收治的经显微手术切除三脑室内肿瘤的42例患者的临床资料，并分析讨论如何预防术中并发症和术后管理。 结果肿瘤全切除者37例，全切除率88.1%，近全切除和大部分切除者5例，无死亡病例。术后近期并发症主要为一过性尿崩症(23例)、电解质紊乱(17例)、中枢性高热(11例)，经处理后1~2周消失；前额硬膜下积气（7例）、额顶部硬膜下积液（3例），均经保守治疗后自行吸收消失；术后短期内记忆力下降、空间分辨力下降者3例，均于3个月内恢复。术后远期并发症有脑积水1例，术后3个月行脑室-腹腔分流术。全组患者均随访3~64个月，全切除的37例，术后随访期间复查头颅MRI未见肿瘤残留及复发；未获全切除的5例术后接受立体定向放射治疗，3例肿瘤增大，接受再次伽玛刀治疗。 结论经胼胝体-透明隔-穹窿间入路处理第三脑室肿瘤，创伤小，能提供清晰、宽广的术野。肿瘤全切除率较高，术后并发症少，是显微手术切除三脑室内肿瘤的理想入路。

Clinical application of the transcallosal-septum-interforniceal approach

ObjectiveTo investigate the surgical indications, advantages and disadvantages of microsurgical resection of three intraventricular tumors through the transcallosal-septum-interforniceal approach, and to discuss the correlative microsurgical anatomy and treatment of postoperative complications. MethodsThe clinical data of 42 patients with three intraventricular tumors who underwent microsurgical resection from September 2004 to August 2017 were retrospectively analyzed. Analysis of how to prevent intraoperative complications and postoperative management. ResultsTotal resection was achieved in 37 cases, total resection rate was 88.1%, near total and subtotal resection in 5 cases, and no deaths. The main complications were diabetes insipidus (23 cases), electrolyte disorder (17 cases), central high fever (11 cases), treated from 1 to 2 weeks to disappear; forehead subdural pneumatosis (7 cases), frontoparietal subdural effusion (3 cases), were treated by conservative treatment on their own absorption and disappeared; postoperative short-term memory loss, spatial resolution decreased in 3 cases, both in the 3 months of recovery. Postoperative long-term complications included hydrocephalus in 1 patient and ventriculoperitoneal shunt in 3 months after operation. All patients were followed up for 3-64 months, 37 cases of total resection, postoperative follow-up period of cranial MRI showed no tumor residual and recurrence; not total resection of 5 cases underwent stereotactic radiotherapy, 3 cases increasing with tumor size, treated with gamma knife. ConclusionThe transcallosal-septum-interforniceal approach for microsurgically removing the third ventricle tumors is a slight trauma, can provide clear and the quite large operation field, and the total resection rate is high, and the postoperative complications are less, which is the ideal approach to microsurgical resection of three intraventricular tumors.