摘要
目的探索手术全切除颅咽管瘤的有效方法。方法３０例颅咽管瘤患者，肿瘤位于鞍上者１７例，进入第三脑室内者１１例，鞍上鞍内者２例。肿瘤钙化１８例，肿瘤完全囊性变者５例，部分囊性变者１７例，完全实性者８例；肿瘤直径２０～６０ｃｍ，平均３３４ｃｍ。均在全麻下翼点入路，术中根据肿瘤位置，从视交叉前间隙，视神经外侧间隙和颈内动脉外侧间隙切除肿瘤。术中除注意第三脑室底神经结构保护外，应防止从颈内动脉、后交通动脉、大脑后动脉及基底动脉发出的穿通动脉的损伤。结果除１例二次手术患者近全切除外，２９例均达到肿瘤全切除。术后２７例参加日常工作，１例需要生活照顾，２例死亡，其中１例死于尿崩症，１例因误吸死亡。结论术中保护下丘脑神经结构和避免其细小穿通动脉的损伤，对安全切除鞍上和三脑室内颅咽管瘤起重要作用。
Objective To study the better method of surgical managementof craniopharygioma. Methods We
treated 30 patients with craniopharyngioma ranged in age from 15 to 55 years (mean:
3413years old). MR image showed that the tumors diameter varied from 20 cm to 60 cm (mean,
334 cm). 17 patients had the tumor in suprasellar region, 11 had tumor extention in the third
ventricle 2 and had the tumor down to insellar. Complete cystic tumor was seen in 5 patients,
partial cystic tumor in 17, and solid tumor in 8. Calcified tumor was found in 18 patients. Frontal
temporal craniotomy was performed in all patients. The tumor was dissected in the
parachiasmal opticocarotid,carotidotentorial spaces and lamina terminals. Great attention was
paid to the preservation of the perforating arteries from the carotid, posterior and anterior
communication and anterior choroidal arteries to the structure of the hypothalamus. The solid
portion of the tumor was removed by piecemeal. Results The tumor was totally removed in 29
patients and subtotally removed in 1 patient by second surgery. Followup showed that 27
patients resamed normal life, 1 patient needed assistance, 1 died 7 days after surgery from
inhalation asphyxia, and 1 died from complications of diabetes insipidus. Conclusions Many
different surgical approaches can be used in the treatment of carniopharyngioma according to
the localization and extension of the tumor. However, avoidance of the neural structures injury
in the third ventricle and preservation of the perforating anteries to hypothalamus are essential
to achieving a good surgical result.
出处
《中华外科杂志》
CAS
CSCD
北大核心
1999年第6期355-357,共3页
Chinese Journal of Surgery
