侧脑室肿瘤的显微外科治疗

Microsurgery treating lateral ventricle tumors

目的探讨侧脑室肿瘤的不同手术入路及显微手术的价值。方法回顾性分析我科1995年1月～2005年12月间收治的侧脑室肿瘤85例,肉眼下手术39例,显微镜下手术46例。经胼胝体前入路手术20例,经皮质前入路手术24例,经皮质后入路手术23例,经胼胝体后入路手术8例,,经颞叶入路手术10例。其中50例患者手术前常规行腰穿蛛网膜下腔置管,手术开始后缓慢释放脑脊液降颅压,术后保留24～48h。结果显微手术组手术全切率及大部切除率明显优于肉眼下手术组(P=0.000<0.001),显微手术组的愈后亦明显优于肉眼下手术组(P=0.012<0.05)。腰穿置管引流组的并发症明显低于未引流组(P=0.040<0.05)。结论选择准确的手术入路、显微镜下手术,可提高侧脑室肿瘤的全切率,减少并发症。腰穿置管引流脑脊液可减少术后并发症。

Objective To explore the value of different operative approach and microsurgery in the treatment of lateral ventricle tumor.Methods Retrospectively study 85 cases of lateral ventricle tumors in the department from January 1995 to December 2005,39 cases was conducted in the naked eye,46 cases was conducted in the microscope;The anterior transcallosal approach was used in 20 patients,an anterior transcortical approach was used in 24 patients,a posterior transcortical approach was used in 23 patients,a posterior transcallosal approach was used in 8 patients,a transtemporal approach was used in 10 cases;In 50 cases,with the approach of lumbar puncture,a pipe was routinely inserted in the subarachnoid cavity(subarachnoid drains)Preoperatively,cerebrospinal fluid was released slowly in the operation,subarachnoid drains was remained from 12 to 24 hours postoperatively.Results the rate of total resection and subtotal resection in the microscope was excelled significantly(P=0.000<0.001),and postoperative clinical evaluation of microsurgery was better than group conducted in the naked eye,too(P=0.012<0.05).In the group of subarachnoid drains,postoperative complication decreased significantly(P=0.040<0.05)?Conclusions Suitable operative approach and microsurgery can increase the rat of total resection,seemly decrease the complication;subarachnoid drains can decrease postoperative complication.