显微手术治疗第三脑室肿瘤

目的探讨显微手术治疗第三脑室肿瘤的手术入路和技术。方法采用显微手术和不同的手术入路切除第三脑室肿瘤36例，其中15例采用胼胝体入路（10例室间孔入路，5例经穹窿间入路），8例采用幕下小脑上入路，8例采用终板入路，5例采用额上同入路。7例术后脑积水，其中3例行脑室一腹腔分流（v—P分流）、1例行第三脑室底造瘘术，1例侧脑室扩大的局限性脑积水行透明隔造瘘术，2例放弃治疗。结果全切除肿瘤22例、次全切除8例、部分切除6例。术后3个月随访结果：良好33例，差1例，死亡2例；远期随访结果（3个月至7年）：良好26例，死亡8例。11例术后需要激素长期替代治疗。结论第三脑室肿瘤手术难度较大，但选择适合的手术入路和熟练的显微手术技术可以取得满意的疗效。

Microsurgical treatment of tumors in third ventricle

Objective To investigate the surgical approaches and techniques of microsurgieal treatment for tumors in the third ventricle. Methods A total of 36 patients with third ventdeular tumors were treated by microsurgery using different surgical approaches. Fifteen cases were performed by transcallosal approach （10 cases by transforaminal approach and 5 cases by interfomiceal approach）, 8 cases by infratentorial supracerebellar approach, 8 cases by trans-larnlna terminalis approach and 5 eases through superior frontal gyrus. Post-operative hydrocephalus happened in 7 cases. Treatment included ventriculoperitoneal shunting （V-P shunting） in 3 cases, third ventriculostomy in 1 case and septostomy in 1 ease with lateral cerebral ventricle enlargement. The other 2 cases gave up further treatment. Results Total removal was achieved in 22 cases, subtotal removal in 8 cases, and partial resection in 6 eases. ~laree-month follow-up showed that there were good effect in 33 patients, poor effect in I patient and 2 patients died. Long-tertn follow-up （3 months to 7 years） showed that go~xt effects were achieved in 26 cases and 8 patients died. Eleven patients need long-term endocrine replacement therapy. Conclusion Resection of third ventricle tumors is difficult, but combination of suitable surgical approach and experienced microsurgical techniques can gain good curative effects.