垂体柄的影像学辩认在颅咽管瘤手术中的意义

目的：探讨颅咽管瘤影像学特点，重点讨论垂体柄的影像学表现及其在手术中的意义。方法：对63例经手术治疗颅咽管瘤的影像学及手术资料进行分析。结果：影像学上垂体柄发现率9．5％（6／63），27．0％（17／63）的病人可根据三脑室底受压移位的方向初步判断垂体柄的走向，均经手术证实。垂体柄术中发现率52．4％（33／63）。肿瘤中心大块钙化可能影像手术全切除，影像学上肿瘤后上部条索状强化预示着瘤壁对下丘脑的浸润性生长。结论：根据影像学判断垂体柄的位置和走行、 肿瘤钙化特点、肿瘤后部与下丘脑结构间的关系对手术切除颅咽管瘤至关重要。

Significance of radiological identification of the pituitary stalk in surgical removal of craniopharyngiomas.

OBJECTIVE: To explore the radiological characteristics of craniopharyngiomas and particularly, to discuss the radiological manifestations of the pituitary stalk and their significance in safe resection of craniopharyngiomas. METHODS: Retrospective analyses of the data obtained in preoperative radiological evaluation and intraoperative observation were conducted in 63 cases of craniopharyngiomas that were surgically removed. RESULTS: In 6 cases (9.5%) the pituitary stalk was identified in preoperative radiological examination, and in 17 cases (27%) the position and course of pituitary stalk could be presumed according to the displacement of the third ventricle floor, which were confirmed in all cases during the operation. While in the other 33 (52.5%) cases, the pituitary stalk was only located during the operation. Massive calcification in the central position of the tumor stood in the way of achieving complete tumor removal, and the irregular peripheral enhancement in the superoposterior part of the tumor indicated tumor invasion of the hypothalamus. CONCLUSION: Preoperative identification of the pituitary stalk and tumor calcification, together with a clear understanding of the position of the posterior part of the tumor in association with the hypothalamus is crucial to safe and complete surgical removal of craniopharyngiomas.