CAJ | 학술논문

目的探讨双侧额底纵裂入路显微切除大型鞍区、鞍后或者长入第三脑室肿瘤的手术策略. 方法潍坊市人民医院神经外科自2002年1月至2013年1月应用双侧额底纵裂入路显微切除56例大型鞍区、鞍后或者长入第三脑室肿瘤,回顾性分析患者的临床资料和疗效,总结双侧额底纵裂入路在切除此类肿瘤手术中的优越性及注意事项. 结果本组肿瘤全切除49例(88％),次全切除7例(12％);术中垂体柄保留47例(84％),断裂4例(7％),5例(9％)未见垂体柄;术中嗅神经保护完好50例(89％),单侧损伤6例(11％);术前视力下降或者视野缺损的41例患者中,术后6个月较术前好转39例,无变化2例;无手术死亡病例,无颅内感染病例;单侧嗅觉丧失2例,额叶轻度水肿2例,3周后水肿消失;脑脊液漏1例,经腰大池引流后2周脑脊液漏停止;尿崩30例,1个月内尿崩消失25例,2～6个月尿崩消失5例;术后1年随访,GOS评分5分(恢复良好)56例(100％),4(7％)例肿瘤大部分切除患者复发再次手术. 结论经额底纵裂入路有利于切除大型鞍区、鞍后或者长入第三脑室肿瘤,术野显露充分,便于保留垂体柄、下丘脑、重要穿支动脉、前交通动脉复合体、视神经、视交叉等重要结构,肿瘤全切率高,并发症少,疗效好.
목적 탐토쌍측액저종렬입로현미절제대형안구、안후혹자장입제삼뇌실종류적수술책략. 방법 유방시인민의원신경외과자2002년1월지2013년1월응용쌍측액저종렬입로현미절제56례대형안구、안후혹자장입제삼뇌실종류,회고성분석환자적림상자료화료효,총결쌍측액저종렬입로재절제차류종류수술중적우월성급주의사항. 결과 본조종류전절제49례(88％),차전절제7례(12％);술중수체병보류47례(84％),단렬4례(7％),5례(9％)미견수체병;술중후신경보호완호50례(89％),단측손상6례(11％);술전시력하강혹자시야결손적41례환자중,술후6개월교술전호전39례,무변화2례;무수술사망병례,무로내감염병례;단측후각상실2례,액협경도수종2례,3주후수종소실;뇌척액루1례,경요대지인류후2주뇌척액루정지;뇨붕30례,1개월내뇨붕소실25례,2～6개월뇨붕소실5례;술후1년수방,GOS평분5분(회복량호)56례(100％),4(7％)례종류대부분절제환자복발재차수술. 결론 경액저종렬입로유리우절제대형안구、안후혹자장입제삼뇌실종류,술야현로충분,편우보류수체병、하구뇌、중요천지동맥、전교통동맥복합체、시신경、시교차등중요결구,종류전절솔고,병발증소,료효호.
Objective To summarize the microsurgical techniques for removal of large neoplasms located in the suprasellar,back of sellar region and anterior part of third ventricle through bilateral frontobasal interhemispheric approach.Methods Fifty-six patients with large neoplasms located in the suprasellar,back of sellar region and anterior part of third ventricle,admitted to our hospital from January 2002 to January 2013 and performed removal via bilateral frontobasal interhemispheric approach; their clinical data and treatment efficacy were analyzed retrospectively.The microsurgical techniques were summarized,and the factors affecting the prognosis were analyzed.Results Total removal of the tumors was achieved in 49 patients (88％) and subtotal removal in 7 (12％).The pituitary stalk was reserved in 47 patients (84％),severed in 4 (7％),and unidentified in 5 (9％).The bilateral olfactory nerves were successfully preserved in 50 patients (89％) and unilateral severed in 6 (11％).Visual impairment was found in 41 patients before surgery,39 of them achieved postoperative visual improvement and 2 patients had no change during the follow-up at 6 months.In our series,there were no procedure-related mortalities and bacterial meningitis.Unilateral anosmia was detected on examination in 2 patients.Minimal frontal lobe contusion developed in 2 patients but resolved within 3 weeks.Cerebrospinal fluid leakage occurred in 1 patient,which was cured for 2 week.Transient diabetus insipidus developed in 25 patients but resolved within 1 month; permanent postoperative diabetes insipidus was present in 5 patients during the follow-up at 6 months.During the follow-up of 12 months,56 patients (100％) gained Glasgow outcome scale (GOS) scores of 5,only 4 (7％) patients with tumors resected partially had tumor relapse and received surgery again.Conclusions The bilateral frontobasal interhemispheric approach is appropriate for removing tumors located in the suprasellar,back of sellar region and anterior part of third ventricle.With sufficient exposure of lesion,the important anatomic structures such as the pituitary stalk,hypothalamic structure,perforating vessels,anterior communicating complex,the visual pathway,and the olfactory nerves could be preserved effectively.The surgery via this approach can increase total removal rate of the tumors,decrease the complications and achieve a good outcome.