海马及脑岛区胶质瘤的手术治疗探讨

目的提高海马及脑岛区胶质瘤的手术治疗效果，分析影响预后的因素，提高治疗质量。方法结合颞叶内侧面及脑岛的显微解剖特点，回顾性分析了近年来我科经外侧裂显微外科治疗的海马及脑岛区22例胶质瘤的临床资料，包括临床表现、诊断和手术方式的选择及治疗结果。结果22例胶质瘤中，肿瘤位于海马14例，脑岛8例。术后病理按WHO分级分类，提示星形细胞的肿瘤12例，间变型星形细胞瘤6例，少突胶质细胞的肿瘤4例。在显微镜下行肿瘤全切除＋海马杏仁核切除14例，次全切除8例。术后症状较术前明显改善的有14例，不变6例，加重2例，无手术死亡。结论术前充分了解肿瘤的解剖位置和周围结构的毗邻关系，充分解剖外侧裂，利用脑组织的自然解剖间隙，采用显微外科技术切除肿瘤是手术的关键，肿瘤的性质、级别，患者年龄、全身状况是影响肿瘤切除及其预后的重要因素。

Microsurgicai treatment for gliomas in hippocampus and insular lobe

Objective To improve the outcomes of surgical treatment for gliomas located in hippocampus and insular region,analysis the factors influencing the prognosis of patients.Methods Considering microanatomy of medial temporal lobe and insular lobe,we retrospectively summarized the clinical manifestations,diagnosis,surgical approaches,prognosis and outcome in 22 cases of gliomas in hippocampus(n=14)and insular lobe(n=8)surgically treated by transsylvian approaches.Results Clinical manifestations showed seizures in 14 cases,progressive memory loss in 4 cases and common symptoms such as headache in 4 cases.According to WHO classification of pathology,there were 12 cases of astrocytomas,6 cases of anaplastic astrocytomas,4 cases of oligodendrocytomas.Under a microscope,14 cases underwent the total removal of gliomas and hippocampal amygdaloid nucleus by microneurosurgery;8 cases received the subtotal removal.After surgery,14 cases had obviously improved symptoms,6 remained unchanged and 2 got worsen,but none died from the surgery. Conclusion It is important to understand the location of the tumors and its detailed anatomic relationship with the surrounding tissue,and to dissect the sulcus for removing the tumors with microneurosurgical skills through the natural anatomic space.The type,grade of tumors,the age and general condition of patients are important factors which affect the tumor removal,therapeutic outcome and prognosis.