经胼胝体-穹窿间入路显微手术切除第三脑室肿瘤

目的探讨经胼胝体-穹窿间入路显微手术切除第三脑室肿瘤的方法，并对相应的显微解剖学基础加以讨论。方法经胼胝体-穹窿间入路显微手术切除第三脑室肿瘤12例，其中突入第三脑室颅咽管瘤8例，丘脑内侧型胶质瘤2型，室管膜瘤1例，畸胎瘤1例。结论10例在手术显微镜下肿瘤全切，2例次全切除，全切除率83．3％，其中8例颅咽管瘤中7例全切，术后复查头颅MR未见肿瘤残留及复发。无死亡病例，近期并发症主要为多饮、多尿、电解质紊乱。经处理后1-2周消失。远期并发症为2例脑积水，其中1例半年后行脑室腹腔分流，2例硬膜下积液，3月后自行吸收。全组病例随访最短2个月，最长2年半，1例颅咽管瘤大部切除8月后复发，1例丘脑胶质瘤术后1年复发，其余10例中9例生活正常，1例生活自理。结论经胼胝体-穹窿间入路显微手术切除第三脑室肿瘤系通过胚胎组织残留的组织间隙进入第三脑室，几乎不损伤正常脑组织，手术视野大，直视下操作，可切除第三脑室前、中、后各部位肿瘤，肿瘤全切除率高，并发症少。

Transcallosum interfornix approach to microsurgically remove the tumors of the third ventricle

Objevtive To explore the microsurgical methods for resecting the tumors of the third ven- tricle and discuss the anatomic foundation of mircrosurgical methods.Methods Twelve patients with tumors of third ventricle were operated on via approach of transcallosum interfornix.Pathologic diagnoses included eight craniopharyngiomas intruding the third ventricle,two gliomas in medial thalamus,one ependymoma and one teratoma.Results Total removal in microscope of the tumors were achieved in 10 cases and subtotal re- moval in 2 cases.The percentage of total resections achieved to 83.3%.Seven of eight craniopharyngiomas were totally resected and the postoperative MR indicated no remanent or recurrent tumors.No death occurred in all cases and the recent complications which were disappeared after one or two weeks' management mostly included polydipsia,diuresis and electrolyte disturbances.Long termed complications included two hydren- cephalus and two spontaneously absorbed subdural fluidifies ventricle-abodminal shunt was performed in one case.The time of follow-up continued were between two months to two and a half years.One subtotal resected craniopharyngiomas was relapesed in eight months,one glioma in thalamus was relapesed in one year and in the remanent ten cases nine can live normally and one can live with self-care.Conclusion Transcallosum interfornix approach for microsurgically removing the third ventricle tumors reached the third ventricle through the rudimental tissue space of embryonic tissue.It can provide a slight trauma,a quite large operative field, euthyhoria for operating.We can use this appoach to resect the tumors located in all directions in the third ven- tricle.The percentage of total resection was large and few complications occurred.