经前纵裂胼胝体入路切除第三脑室前、中、后部肿瘤简

目的探讨经前纵裂胼胝体入路切除第三脑室前、中、后部肿瘤的可行性和优势。方法回顾性分析153例第三脑室肿瘤病人的临床资料。病人均经前纵裂胼胝体人路行显微手术，术中行第三脑室底造瘘。术前MRI示肿瘤位于第三脑室前部68例（44．4％），第三脑室中部36例（23．5％），第三脑室后部49例（32．0％）。结果术后MRI证实手术全切123例（80．4％）．大部切除26例（17．0％），部分切除4例（2．6％）。术后并发症：神经功能障碍45例（29．4％），脑室内出血13例（8．5％），癫痫15例（9．8％），脑积水14例（9．2％）。随访153例，时间3个月一5年。死亡15例，肿瘤复发或进展55例，其中2l例再次手术。结论经前纵裂胼胝体入路对第三脑室前、中、后部肿瘤暴露良好，可直视下切除肿瘤，手术全切率高。联合术中第三脑室底造瘘．术后并发症少。

Resection of tumors in the anterior,middle or posterior third ventricle via anterior interhemispheric transcallosal approach

Objective To explore the feasibility and advantage of resection of tumors in the anterior, middle or posterior third ventricle via the anterior interhemispheric transcallosal approach. Methods Clinical data of 153 patients with tumor in third ventricle were analyzed retrospectively. All patients underwent microsurgery via the anterior interhemispheric transcallosal approach and intraoperative third ventriculostomy. Preoperative MRI revealed that 68 （44.4%） patients with tumors located in the anterior, 36 （23.5%） in the middle and 49 （32.0%） in the posterior third ventricle. Results Total resection was achieved in 123 patients （80.4%）, major resection in 26 （17.0%） and partial resection in 4 （2.6%）. The main postoperative complications included neurological dysfunction in 45 patients （29.4%）, intraventricular hemorrhage in 13 （8.5%）, epilepsy in 15 （9.8%）, hydrocephalus in 14 （9.2%）. All the patients were followed up for 3 months to 5 years. Tumor relapse or progression occurred in 55 patients and 21 out of them received the second surgery. Conclusions The anterior interhemispheric transcallosal approach can provide a good exposure of the tumors in the anterior, middle or posterior third ventricle and direct corridor to the lesion, which enables the surgeon to remove tumor under direct vision with high total resection rate. And this approach in combination with intraoperative third ventriculostomy can result in fewer complications.