CAJ | 학술논문

目的探讨锁孔入路手术切除脑室肿瘤的可行性及其技术方法.方法收集2010年1月至2014年12月苏州大学附属第二医院神经外科收治的脑室肿瘤患者共25例,肿瘤平均大小为38.04 cm3,均采用锁孔手术入路进行肿瘤切除.肿瘤位于侧脑室8例,其中经纵裂胼胝体手术1例,经皮质手术7例;第三脑室肿瘤7例,其中经纵裂胼胝体入路4例,经眉弓入路2例,经枕部皮质手术1例;第四脑室肿瘤10例,均经枕下正中入路手术.7例侧脑室肿瘤以及5例第三脑室肿瘤在神经导航下设计手术入路并进行术中导航确认.结果 25例脑室肿瘤中,全切除23例,次全切除2例.术前明显脑积水者9例,术后6例脑积水消退,行脑室穿刺外引流及脑室-腹腔引流术各1例,另1例术前行脑室-腹腔引流术.术后肿瘤残腔出血1例,再次手术清除血肿,行去骨瓣减压,出院时神志清楚,伴有不全性失语及肢体偏瘫.其余患者出院时,神志清楚,无肢体活动障碍.结论脑室系统位置深在,适合利用锁孔放大效应对手术野进行充分有效的暴露;通过对脑室系统的脑脊液释放,可有效降低颅内压,增加手术显露空间;术前合并脑积水患者在术后脑脊液循环通畅后,脑积水多可消退,无需常规行脑室-腹腔引流术.
목적 탐토쇄공입로수술절제뇌실종류적가행성급기기술방법.방법 수집2010년1월지2014년12월소주대학부속제이의원신경외과수치적뇌실종류환자공25례,종류평균대소위38.04 cm3,균채용쇄공수술입로진행종류절제.종류위우측뇌실8례,기중경종렬변지체수술1례,경피질수술7례;제삼뇌실종류7례,기중경종렬변지체입로4례,경미궁입로2례,경침부피질수술1례;제사뇌실종류10례,균경침하정중입로수술.7례측뇌실종류이급5례제삼뇌실종류재신경도항하설계수술입로병진행술중도항학인.결과 25례뇌실종류중,전절제23례,차전절제2례.술전명현뇌적수자9례,술후6례뇌적수소퇴,행뇌실천자외인류급뇌실-복강인류술각1례,령1례술전행뇌실-복강인류술.술후종류잔강출혈1례,재차수술청제혈종,행거골판감압,출원시신지청초,반유불전성실어급지체편탄.기여환자출원시,신지청초,무지체활동장애.결론 뇌실계통위치심재,괄합이용쇄공방대효응대수술야진행충분유효적폭로;통과대뇌실계통적뇌척액석방,가유효강저로내압,증가수술현로공간;술전합병뇌적수환자재술후뇌척액순배통창후,뇌적수다가소퇴,무수상규행뇌실-복강인류술.
Objective To investigate the feasibility and its technical methods of keyhole approach for removal of ventricular tumors.Methods A total of 25 patients with ventricular tumor admitted to the Department of Neurosurgery, the Second Affiliated Hospital of Soochow University from January 2010 to December 2014 were collected.The average tumor size was 38.04 cm3.All the tumors were resected via the keyhole surgical approach.The tumors of 8 patients were located in the lateral ventricles;one of them was operated via the interhemispheric transcallosal approach and 7 were operated via the cortical approach.Seven patients had the third ventricle tumor, 4 of them were resected via the interhemispheric transcallosal approach, and 2 via the supraorbital approach, and 1 via the occipital cortex.Ten patients with the fourth ventricle tumor were resected via the suboccipital midline approach.The surgical approach in 7 patients with lateral ventricle tumor and 5 with the third ventricle tumor were designed under the neuronavigation and were identified by the intraoperative navigation.Results Of the 25 patients with intraventricular tumor, 23 were totally removed and 2 were subtotally removed.Before procedure, 9 patients had obvious hydrocephalus.The hydrocephalus of 6 cases disappeared after procedure.One patient was performed ventricular puncture drainage and 1 was performed ventriclar-peritoneal drainage, and another one was performed preoperative ventricular-peritoneal drainage.One patient had residual tumor hemorrhage after procedure and was reoperated for hematoma evacuation and decompressive craniectomy.The consciousness of the patient was clear at discharge with partly aphasia and hemiparalysia.No neurologic morbidity was observed when other patients were discharged.Conclusions The position of the ventricular system is deep inside.It is suitable for using keyhole amplification effect to adequately and effectively expose surgical fields.It can effectively decrease intracranial pressure and increase surgical expose space by releasing cerebrospinal fluid through the ventricular system.Most of hydrocephalus can be subsided in patients with preoperative hydrocephalus after postoperative cerebrospinal fluid circtlation smooth.There is no need for routine ventricular-peritoneal drainage.