侧脑室内肿瘤显微手术治疗(附65例报告)

目的 总结侧脑室内肿瘤显微手术治疗的方法特点和所遇到的问题。方法 回顾分析近7年收治的65例侧脑室内肿瘤的病变特征、显微手术方法与问题、辅助治疗和结果等。结果 全切除52例，次全切除9例，部分切除4例。术后手术相关并发症：视野缺损8例、丘脑与基底节区水肿5例、暂时性不全偏瘫3例、失联系症状2例、平衡障碍2例、注意力缺损1例、暂时语言障碍1例。术后非手术入路相关并发症：脑积水11例，脑室内血肿6例，短暂意识障碍6例，脑室内感染3例，硬膜下血肿2例。手术死亡2例，长期昏迷1例。辅助治疗：放疗12例、化疗10例，放疗 化疗14例。随访6个月～8年，失访7例。术后6个月采用Kamofsky评分，80～90分42例，60～70分13例，40～50分2例，10～20分1例。结论 侧脑室内肿瘤以室管膜瘤、脑膜瘤、中枢神经细胞瘤、脉络丛乳头状瘤和星形细胞瘤多见，但各有好发的具体部位。多数起源位于脑室内，也可为脑室周围的结构向脑室突入所致。生长缓慢且发现时体积较大。显微手术为主要治疗方法，各手术入路都有手术难点和内在的并发症，其选择应根据病变的特征做决定。手术中争取全切，但不可强行全切，残留部分可接受放疗和／或化疗。

Microsurgery for lateral ventricle tumors: report of 65 cases

Objective To summarize the characteristics of the methods and the problems in the microsurgery of lateral ventricle tumors. Methods The features of lesions,methods and problems of microsurgery,supplementary therapies and the results of 65 cases of lateral ventricle tumors in the last 7 years were analyzed retrospectively. Results Types of lesions: meningiomas 18 cases,ependymomas 13 cases,astrocytomas 9 cases,central neurocytomas 8 cases,choroid plexus papillomas 5 cases,oligodendrogliomas 4 cases,subependymomas 2 cases,metastasis 2 cases,hemangioblastoma 1 case,teratoma 1 case,epidermoid 1 case,choroidal cyst 1 case. Locations of lesions: 15 cases in the anterior horns with ependymomas and astrocytomas frequently,23 cases in the bodies with ependymomas and central neurocytomas frequently,22 cases in the trigone areas and occipital horns with meningiomas and choroid plexus papillomas frequently,and 5 cases in the temporal horns with ependymomas and meningiomas frequently. Operative approaches: anterior transcortical approach for entering the anterior horn; anterior transcallosal approach for entering the body and anterior horn; posterior transcallosal approach,posterior transcortical approach or occipital approach,and posterior transtemporal approach for entering the trigone area and occipital horn; posterior transtemporal approach or inferior temporal sulcus incision for the temporal horn. Operative results: 52 cases with total resection,9 cases with subtotal resection and 4 cases with partial resection. Postoperative intrinsic complications: t defection of optic field 8 cases,edema of basic ganglion area and thalamus 5 cases ,transient hemiparesis 3 cases,disconnection 2 cases,balance disturbance 2 cases,attention deficit 1 case,transient speech difficulty 1 case. Other complications after operation: hydrocephalus 11 cases,intraventricular hematomas 6 cases,transient unconsciousness 6 cases,intraventricular infections 3 cases,subdural hematomas 2 cases. Death after operation 2 cases,long term coma 1 cases. Complementary therapies: radiotherapy 12 cases,chemotherapy 10 cases,and combined radiotherapy and chemotherapy 14 cases. Postoperative follow-up was performed from 6 months to 7 years. 7 cases were lost. Karofsky performance status was evaluated at the sixth month postoperatively with the results of 80~90 scores in 42 cases,60~70 scores in 13 cases,40~50 scores in 2 cases,10~20 scores in 1 cases. Conclusion Lateral ventricles are mainly with ependymoma,meningioma,central neurocytoma,choroid plexus papilloma and astrocytoma,and they have their main locations differently. Most of these lesions originate from and mainly locate in the lateral ventricles,although they could originate from the surrounding structures and protrude into the lateral ventricles. They grow slowly and are found large in volume. Microsurgery is the main therapy for them. Every approach has it own difficulties and intrinsic complications,and the choice of approach should depend upon the features of lesion. Operation should aim at total resection,but not try to force this. The remainder of lesion may be treated with radiotherapy and/or chemotherapy.