颅咽管瘤手术入路的选择及术后并发症的防治

目的 探讨颅咽管瘤的手术入路选择及并发症防治措施.方法 对32例颅咽管瘤患者选用不同的手术入路,其中经翼点和改良翼点入路16例,胼胝体-透明隔间隙-穹隆间入路4例,前纵裂-终板联合额下入路12例.结果 肿瘤全切除25例,次全切除7例.术后死亡1例.主要并发症:尿崩症15例,电解质紊乱24例.结论 对颅咽管瘤患者选择合适的手术入路,有利于在直视下显露并全切除肿瘤;熟悉鞍区的解剖关系并重视术中对下丘脑的保护,是降低术后并发症的重要环节.

Selection of surgical approach and postoperative complications for craniopharyngiomas

Objective To investigate the surgical approach selection for craniopharyngioma and explore the preventive and therapeutic strategies for surgical complications. Methods 32 patients with craniopharyngiomas were operated through different approaches, including pterional and modified pterional approach in 16 cases, transcallosal - interseptal - interforniceal in 4, and transfrontal interhemispheric combined with subfrontal in 12. Result Total removal of tumor was achieved in 25 cases and subtotal in 7.After the surgery, 1 case died. The major postoperative complications included diabetes insipidus in 15 cases and electrolyte disturbance in 24 cases. Conclusions Choosing appropriate approach is helpful for direct exposure and total removal of craniopharyngioma. Skilled microsurgical techniques, acquaintance with anatomy of sellar region and protection of hypothalamus are the keys for preventing postoperative complications.