颅咽管瘤的手术入路选择(附56例分析)

目的 探讨鞍区颅咽管瘤的手术入路选择及并发症防治措施.方法 对56例颅咽管瘤病人选用不同的手术入路切除肿瘤,其中经翼点和改良翼点入路34例,额下入路11例,胼胝体-透明膈间隙-穹隆间入路6例,前纵裂-终板联合额下入路5例.结果 肿瘤全切除32例（57.1%）,近全切除17例（30.4%）,大部分切除7例（12.5%）.术后死亡1例.主要并发症：尿崩症18例（32.1%）,电解质紊乱26例（46.4%）.结论 对颅咽管瘤病人选择合适的手术入路,有利于在直视下显露并全切除肿瘤;熟练的显微神经外科技术,熟悉鞍区的解剖关系并重视术中对下丘脑的保护,是降低术后并发症的重要环节.

Approach selection for craniopharyngiomas: analysis of 56 cases

Objective To investigate the surgical approach selection for craniopharyngioma, and explore the preventive and therapeutic strategies for surgical complications. Methods Fifty-six patients with craniopharyngiomas were operated on via different approaches, including pterional and modified pterional in 34 cases, subfrontal in 11, transcallosal-interseptal-interforniceal in 6, and transfrontal interhemispheric combined with transsubfrontal in 5. Results Total removal of the tumor was achieved in 32 cases (57.1%), subtotal in 17 (30.4%), and partial in 7 (12.5%). After the surgery, 1 case died (1.8%). Major postoperative complications included diabetes insipidus in 18 cases (32.1%) and electrolyte disturbance in 26 (46.4%). Conclusion Choosing appropriate approaches is helpful to directly expose and totally remove the craniopharyngioma. Skilled microsurgical techniques, acquaintance with the anatomy in the saddle area and protecting hypothalamus from injury are the keys for preventing postoperative complications.