松果体区肿瘤的手术治疗分析

目的 探讨松果体区肿瘤的临床特征及手术效果。方法 回顾性分析2016年1月至2021年1月手术治疗的17例松果体区肿瘤的临床资料。结果 采用Krause入路9例，Poppen入路8例。1例行脑室-腹腔分流术及放疗无效后行手术切除肿瘤；6例行脑室外穿刺引流术+肿瘤切除术，5例行脑室镜下第三脑室造瘘术+肿瘤切除术，1例行脑室穿刺引流+第三脑室造瘘术+肿瘤切除术。肿瘤全切除8例，次全切除6例，部分切除3例。术后1例因迟发性颅内出血死亡，1例梗阻性脑积水加重，2例眼球活动障碍。术后病理结果显示，生殖源性肿瘤6例，胶质瘤4例，表皮样囊肿1例，黑色素细胞瘤1例，脑膜瘤1例，松果体乳头状瘤1例，血管瘤1例，毛细血管性血管母细胞瘤1例，血管周细胞瘤1例。16例存活者术后随访4～58个月，平均（29.8±20.7）个月；术后8例行放疗，3例化疗，2例行放疗+化疗；12例无症状生存，3例胶质母细胞瘤术后半年内死亡，1例死于其他疾病。结论 松果体区肿瘤病理类型复杂，预后差异较大，治疗方法各异，但手术切除肿瘤仍然是治疗松果体区肿瘤的重要手段，脑室-腹腔分流术是解决继发性脑积水的可靠方式。

Clinical features and surgical outcomes of patients with pineal region tumor: report of 17 cases and literature review

Objective To investigate the clinical features and surgical outcomes of patients with pineal region tumors (PRTs). Methods The clinical data of 17 patients with PRTs who underwent surgery from January 2016 to January 2021 were retrospectively analyzed. Results The Krause approach was used in 9 patients and the Poppen approach in 8. One patient underwent tumor resection after ventriculoperitoneal shunt and failed radiotherapy, 6 underwent external ventricular drainage+tumor resection, 5 underwent ventriculoscopic third ventriculostomy+tumor resection, and 1 underwent ventriculopuncture drainage+third ventriculostomy+tumor resection. Total tumor resection was achieved in 8 patients, subtotal in 6, and partial in 3. After the operation, 1 patient died due to delayed intracranial hemorrhage. Obstructive hydrocephalus was aggravated in 1 patient. Impaired eye movement occurred in 2 patients. Postoperative pathological results showed a reproductive tumor in 6 patients, glioma in 4, epidermoid cyst in 1, melanocytoma in 1, meningioma in 1, pineal papilloma in 1, hemangioma in 1, capillary angioblastoma in 1 and hemangiocytoma in 1. The 16 survivors were followed up for 4 to 58 months, with an average of (29.8±20.7) months. After surgery, 8 patients received radiotherapy, 3 received chemotherapy, and 2 received radiotherapy+chemotherapy. Twelve patients survived asymptomatic, three died of glioblastoma within six months after surgery, and one died of other diseases. Conclusions PRTs have complex pathologic types, different prognoses, and different treatment methods. Surgical resection is important to treat PRTs, and the ventriculoperitoneal shunt is a reliable way to solve secondary hydrocephalus.