脑干肿瘤显微手术治疗的回顾性分析

目的探讨脑干肿瘤手术治疗方法。方法对笔者所在医院连续收治的52例脑干肿瘤患者的资料进行回顾性分析。中脑被盖7例,大脑脚2例,桥脑腹侧10例,桥脑臂8例,前后贯穿桥脑2例,桥脑-延髓4例,延髓15例,延颈4例。采用五种手术入路:poppen入路5例;经幕下小脑上入路4例;经一侧颞枕小脑幕入路13例;桥小脑角入路7例;枕后正中入路23例。结果镜下全切47例,次全切除5例。病理结果:星形细胞瘤Ⅰ～Ⅱ级18例,毛细胞性星形细胞瘤2例,室管膜瘤5例,海绵状血管瘤19例,血管网状细胞瘤7例,脊索瘤1例。结论合理的入路、术中耐心细致的操作是脑干肿瘤显微手术成功的关键。根据肿瘤性质采用不同的取瘤策略有利于减少手术对脑干的损伤。

Microsurgery for tumors in brain stem: Retrospective analysis of 52 cases

Objective To explore the microsurgical methods of tumors in brain stem. Methods The clinical data of a series of 52 patients with tumors in brain stem managed in author＇s hospital was analyzed retrospectively. Of 52 cases, 9 were located in the mesencephalon, 20 in the pons and brachia pontis, 4 in the ponto-oblongata, 15 in the oblongata, and 4 in the cervix-oblongata. Approach craniotomy near the lesion, poppen approach, infratentorial supracerebellar approach,infratemporooccipital approach, ponto -cerebellar angle approach and suboccipipital midline approach. Results The tumors were totally resected in 47 patients, and subtotally in 5 patients. The postoperative pathological results were astrocytomas （grade I- II,18 cases）, Pilocytic astrocytoma （3 cases）,ependymoma （5 cases）, cavernous angiomas （19 cases）, Hemangioblastoma （6 eases）, chordom （1 case）. Conclusion The correct approach and skillful mierosurgical technique are the key points for totally removing the tumors in brain stem. The different stragety on different pattern of tumors are helpful for reducing the surgical injury of brain stem.