松果体区肿瘤的手术治疗

Surgical treatment for tumors of pineal region

目的:旨在进一步提高松果体区肿瘤的手术疗效。方法与结果:回顾性研究23例松果体区肿瘤的治疗情况,本组2例根据影像学特征考虑为生殖细胞瘤,给予脑室-腹腔分流术-放射治疗,结果肿瘤消失,余21例均经枕切开天幕入路显微手术治疗。其小4例同时行脑脊液(CSF)分流术,无手术死亡。术后计算机体层摄影(CT)复查证实肿瘤全切除5例,次全切除9例,大部或部分切除7例。结论:松果体区肿瘤手术难度及危险性大,手术前应参照CT或磁共振成像(MRI)等影像资料。针对肿瘤的具体部位及毗邻等情况,选用适当的治疗方法和合理的手术入路,强调经枕切开天幕入路的优越性、指出显微技术、麻醉方法的改进以及必要的放射治疗可以提高此病的治疗效果。

For the purpose to improve the surgical outcome of the tumors of pineal region. Method and Result: Retrospective analysis of the operative results of 23 cases of pineal region tumors. 2 cases were diagnosed as germinoma according to the image characteristic, they had been given ventriclo-peritoneal shunt and radiotherapy, the tumors disappeared. The remaining 21 cases were undergone microsurgical resection via occipital transtentorial approach, CSF shunt were performed simultaneously in 4 of them, there was no operative mortality. Postoperative CT scan showed that the tumors were totally resected in 5 cases, subtotal in 9, and partialy resected in 7. Conclusion: Operation of pineal region tumors is a difficult and dangerous procedure. Preoperative image such as CT or MRI are helpful to choose appropriate therapeutic measures and rational surgical approach according to the position and adjacent structures of the tumor . The authors emphasized the advantages of occipital transtentorial approach, and subsequent radiotherapy.