经蝶入路显微外科切除颅咽管瘤适应证选择与操作要点

有关颅咽管瘤的手术一直是神经外科医师最感困惑的问题。本文报道经蝶显微手术切除颅咽管瘤18例,均经CT或MRI扫描确诊。本入路适用起源于鞍底或向鞍上扩展的肿物。手术采取经唇下-鼻中隔-蝶窦入路或经鼻前庭-鼻中隔-蝶窦入路两种方式行肿瘤切除术。9例肿瘤获得全切除,4例次全切除,其余5例为部分切除,术后无死亡。15例获长期(平均3.1年)随访,有12例(80.0％)恢复良好,3例影像学检查提示肿瘤复发,需行再次手术,放疗或放射外科治疗。文中对颅咽管瘤手术适应证选择及操作要点进行了讨论。

CHOICE OF INDICATION AND MAIN TECHNICAL POINTS OF TRANSSPHENOIDAL MICROSURGICAL REMOVAL FOR CRANIOPHARYNGIOMAS

The operation on craniopharyngiomas has often been regarded of one of the most difficult problems by neurosurgeons. The craniopharyngiomas were treated by transsphenoidal microsurgery on 18 patients. The transsphenoidal approach is suitable for tumors originated from base of the sella turcica or got suprasellar extension. The diagnosis was made by means of CT or MRI scan. Operations were performed via either sublabio - septo - sphenoidal approach or nasovestibulo - sphenoidal approach. Total removal of the tumor in 9 cases, and subtotal removal in 4 cases and partial removal in 5 cases were achieved. There was no postoperative mortality . Long term follow - up review (median 3.1 years) in 15 patients revealed good recovery of 12 patients (80% ), and late recurrence in 3 cases (20). The patients with recurrence need re - operation, radiotherapy or rediosurgery. The choice of indication and main operating points of transsphenoidal microsurgery for the tumor were discussed.