立体定向手术治疗颅内囊性病变

目的 探讨立体定向手术治疗颅内囊性病变的手术方法 、有效性及优点. 方法 回顾性分析北京军区总医院神经外科自2002年12月至2009年11月采用立体定向手术治疗的29例颅内囊性病变患者(病灶37个)的临床资料,其中颅咽管瘤11例,胶质瘤5例,转移瘤3例,脑脓肿10例.18例肿瘤患者行Ommaya囊置入及32P内放疗32内放疗剂量根据囊性病变体积,平均为800 μCi(500～1500 μCi)],1例单纯抽液后外放疗;10例脑脓肿患者置管引流8例,穿刺冲洗2例.结果 本组无手术出血及死亡患者.患者随访1～60月,平均10.6月,4例因无法联系而失访.11例颅咽管瘤患者(病灶11个)经32P内放疗症状稳定无复发.8例其他肿瘤患者(病灶12个)中有5例控制症状5～48月,3例无效(转移瘤2例,胶质母细胞瘤1例).10例脑脓肿患者(病灶14个)经穿刺引流症状消失治愈.2例颅咽管瘤患者32P内放疗后出现一过性尿崩、低热及呕吐. 结论 立体定向手术对于脑脓肿、囊性颅咽管瘤、体积不大的深部胶质瘤及转移瘤而言,较传统开颅手术具有明显的优势,但对体积较大、难于短期控制瘤液分泌的囊性转移瘤效果不佳.

Stereotactic surgery in treating intracranial cystic lesions

Objective To explore the methods, efficacy and advantages ofstereotactic surgery.Methods A retrospective analysis of 29 consecutive patients with 37 lesions (mean age, 34.6 years),received surgery between Dec 2002 and Nov 2009, was performed. Histological findings showed 11 craniopharyngiomas, 5 cystic gliomas, 3 metastases and 10 cerebral abscesses. Eighteen patients underwent cyst aspiration by the Ommaya reservoir system combined with 32P endocavitary irradiation;median irradiation doses were 800 μCi. One was treated with aspiration and then radiotherapy only. Ten patients with cerebral abscesses received cystic drainage (8 cases) and aspiration (2 cases). Results No operative bleeding and death were found in this experiment. Follow up was performed for a median of 10.6 months (range, 1-60 months) and 4 were out of contact. All patients with craniopharyngiomas remained stable without recurrence after treatment; complete resolution was achieved in all patients with cerebral abscess; in the other 8 patients with tumors(12 lesions), 5 were under control of the symptoms for an average of 14 months and 3 (2 with metastases and 1 with glioblastoma) did not get improvement after the treatment. Two patients with craniopharyngioma experienced a transient slightly worsening of hypothalamic functions, including transient diabetes insipidus, low fever and vomit. Conclusion Stereotactic technique has its advantages in treating patients with cerebral abscess, craniopharyngiomas,metastatic tumors and gliomas that were small size, while it does not that effective in the cystic metastases that are in large size and difficult to control in a short term.