松果体区肿瘤手术治疗方法的选择

目的探讨手术切除松果体区肿瘤的意义、肿瘤切除的程度、手术入路的选择以及脑积水的处理方法。方法我院收治松果体区肿瘤患者23例，为缓解脑积水，先后行脑室一腹腔（V-P）分流术13例，术中同时行终板造瘘术7例，其中2例术后仍需行V—P分流术。经胼胝体．透明隔．穹隆间。第三脑室入路切除肿瘤13例；经枕下小脑幕上入路（Poppen入路）切除肿瘤8例；经幕下小脑上入路（Krause入路）2例。结果肿瘤全切除11例，次全切除＋大部切除8例，部分切除4例。术后单纯放疗9例，术后放疗＋化疗8例，6例未行放、化疗。死亡2例。结论肿瘤偏大，术前诊断＋术中病理诊断为生殖细胞瘤者可不必完全切除肿瘤，但需解决脑脊液循环通路问题，包括V．P分流术、第三脑室底经终板造瘘术，如肿瘤较小且易于切除，估计对周围脑组织影响不大，第Ⅲ、Ⅳ脑室间能保持通畅者可不行分流术或造瘘术，术后放、化疗。其他病理类型肿瘤争取肿瘤全切除，以提高疗效，特别是良性肿瘤。

Microsurgical surgery options for tumors in pineal region

Objective To explore the significance of surgical resection for the pineal region tumor,the extent of tumor resection, the surgical approaches and treatment measures of hydrocephalus. Methods Twentythree patients diagnosed of pineal region cancer were recruited for this study. Thirteen patients received ventriculo-peritoneal shunt（V-P） ,during which 7 cases received intraoperative end-plate colostomy. Two of the 13 cases received a second V-P procedure. Another 13 cases received operation by corpus callosum- septum- Dome Room-the third ventricle approach to remove the tumor; Eight cases underwent the tumor resection by suboccipital supratentorial approach （Poppen approach ）and 2 cases underwent the tumor resection by the infratentorial cerebellar approach（ Kranse approach）. Results Total tumor resection was performed in 11 cases, subtotal or major total resection in 8 cases and partial resection in 4 cases. Nine cases underwent postoperative radiotherapy alone,8 receiving radiotherapy plus chemotherapy, and 6 cases receiving neither radiotherapy nor chemotherapy. Two cases died during treatment. Conclusion Though it is not practicable to completely remove the germ cell tumor in patients with relatively large tumors, cerebrospinal fluid circulation pathways should be reestablished,including ventriculo-peritoneal shunt, colostomy from the end of the third ventricle to the end plate. If tumors are not too large,they would be easy to be removed. The effects on the surrounding brain tissue would not be much significant. If the connection of Ⅲ, Ⅳ ventricles were normal,the patient may not need shunt or colostomy. Radiotherapy and chemotherapy can be given to this kind of patients after the surgery. To improve the efficacy, other types of tumors, expecially the benign tumors, should be totally removed.