颅咽管瘤显微手术入路的选择和评价

目的 探讨颅咽管瘤的手术入路选择.方法 32例颅咽管瘤,常规或扩大翼点入路14例,额下入路3例,额皮层切开经侧脑室-室间孔和额下联合入路5例,经胼胝体-穹窿间入路6例,胼胝体-穹窿间和额下联合入路2例,经额下-前纵裂联合入路2例.结果 肿瘤全切26例,次全切4例,部分切除2例.结论 根据肿瘤的不同分型选择合适的手术入路,是颅咽管瘤全切的关键.对于Samii分型Ⅰ、Ⅱ级应用额下和翼点入路;Ⅲ～Ⅴ级(无扩展)采用经胼胝体-透明隔间隙-穹窿间入路;Samii分型Ⅲ～Ⅴ级(有扩展)的肿瘤可通过胼胝体-透明隔-穹窿间入路联合额下入路、经额皮层造瘘-室间孔入路联合额下入路或经额下前纵裂联合入路均能达到全切除.

Selection and evaluation of operative approaches for microsurgical treatment of craniopharyngioma

Objective To compare and evaluate several operative approaches for microsurgical treatment of craniopharyngiomas.Method Of 32 patients,14 cases were operated via pterional approach,3 via subfrontal approach,5 via transcortical-transforaminal approach combied with subfrontal approach,6 via transcallosal-interseptal-interforniceal approach,2 via transcallosal-interseptal-interforniceal approach combined with subfrontal approach,2 via transfrontal interhemispheric approach.Results Of 32 patients,total removal of tumor was achieved in 26 cases,4 subtotal removal,and 2 partical removal.Conclusions Selection of a suitable operative approach on the basis of different types of tumor is the key for total removal of craniopharyngioma.For Samii types,gradeⅠ～Ⅱcan be operated via subfrontal and pterional approach;grade Ⅲ～Ⅴ (without expansion) can be operated via transcallosal-interseptalinterforniceal approach;grade Ⅲ～Ⅴ(with expansion) can be removed by combined approaches,such as transcallosal- interseptal- interforniceal approach combined with subfrontal approach,transcorticaltransforaminal approach combied with subfrontal approach or transfrontal interhemispheric approach.