经蝶入路显微手术切除鞍膈下颅咽管瘤

目的探讨鞍膈下颅咽管瘤经蝶入路显微手术治疗的效果。方法2003年1月至2013年3月显微手术治疗290例颅咽管瘤,其中29例为鞍膈下颅咽管瘤,行经蝶入路显微手术治疗。术后随访3~116月,采用MRI评估肿瘤切除程度和复发。结果肿瘤全切24例,全切率82.8%;次全切除5例。无手术死亡患者。术后6例出现脑脊液鼻漏,2例行手术修补,4例行腰穿置管,均治愈。术后6例患者出现一过性尿崩,2例出现电解质紊乱,3月后恢复正常。14例术前视力下降患者,12例术后得到不同程度改善。8例术前高泌乳素水平患者术后恢复正常,5例新出现垂体功能障碍,3月后复查恢复正常。1例复发再次经蝶入路显微手术切除肿瘤。结论鞍膈下颅咽管瘤经蝶入路手术可安全切除,创伤小,疗效好。

Clinical effectiveness of microsurgery through transsphenoidal approach for infradiaphragmatic craniopharyngiomas

ObjectiveTo explore the clinical effectiveness of microsurgery through transsphenoidal approach for infradiaphragmatic craniopharyngiomas.MethodsThe clinical data of 29 patients with infradiaphragmatic craniopharyngioma who underwent microsurgery through transsphenoidal approach between 2000 and 2013 were analyzed retrospectively.ResultsTotal resection was achieved in 24 patients（82.7%） and subtotal in 5（17.3%）. Of 14 patients with visual impairment, 12 improved and 2 did not change after operation. Eight patients with hyperprolactinemia recovered 3 months after operation. Cerebrospinal rhinorrhea occurred in 6 patients after operation, of whom, 4 received repair through transnasal sphenoidal approach and 2 received lumbar puncture catheter drainage. Diabetes insipidus occurred in 6 patients after operation and all recovered 3 months after conservative treatment. All patients were followed up for 3~116 months; 1 recurred and received re-operation.ConclusionsThe microsurgery through transsphenoidal approach is a feasible and effective treatment method for infradiaphragmatic craniopharyngiomas.