幕下小脑上入路切除松果体区肿瘤

目的 评估幕下小脑上入路切除松果体区肿瘤的优点和缺点.方法 回顾性分析53例用该种手术入路所切除肿瘤的临床表现、手术方法 、肿瘤全切程度和术后并发症等.结果 28例显微镜下全切,15例大部切除,8例部分切除,2例活检.术后所有患者均出现不同程度的气颅,但在3-5d后消失.术后38例患者出现眼球上视和会聚功能受限,均在术后2周内恢复.4例出现进行性加重脑积水需行脑室-腹腔分流术.2例患者术后肿瘤残腔出血,虽经积极手术治疗仍死亡.结论 幕下小脑上入路能克服经枕穿幕入路牵拉枕叶、切开小脑幕的缺点,术中解削定位清晰,但暴露范围有限,不适于肿瘤向幕上或偏侧生长者.

Removing pineal region tumor with infratentorial-supracerebellar approach

Objective To estimate the advantage and disadvantage of infratentorial-supracerebellar approach for removal of pinal region tumor.Method 53 cases of pineal region tumor were retrospectivly reviewed including clinical manifestations,operative approach,degree of tumor resected and complication related to approach.Results Of 53 cases,28 cases were totally removed,subtotally removed in 15 cases,partly in 8 cases and biopsy in 2 cases.After operation air presented in supratentorial cavity in all cases,but disappeared among 3-5 days.38 cases showed limited upgaze and convergency which lasts several days to 2 weeks.4 cases needed to be shunted to eliminate developing hydrocephalus.2 cases developed postopertive hemorrhage in the residual mass,and undergone second operation and died.Conclusions Infratentorial supracerebellar approach can avoid retracting occipital lobe and dividing tent,but it is preferable for small and medium size tumors without lateral expansion.