儿童颅咽管瘤的显微外科治疗

Microsurgical treatment of craniopharyngiomas in children

目的探讨儿童颅咽管瘤显微外科治疗的手术方法、手术入路和治疗效果.方法回顾性分析33例儿童颅咽管瘤患者显微外科治疗的临床资料.结果33例中肿瘤全切除30例,近全切除3例,无手术死亡及严重并发症,近全切者术后辅助立体定向放射治疗.31例获随访17月～8.1年,平均4.8年.效果良好者28例,需生活照顾者3例,MRI/CT复查未见肿瘤复发.结论显微手术切除肿瘤是儿童颅咽管瘤有效的治疗措施;额颞-眶入路能明显缩短到达肿瘤的距离,能显著提高颅咽管瘤手术切除效果.

Objective To explore the microsurgical technique, transorbital subffontal approach and therapeutic efficacy of the children craniopharyngiomas. Methods The retrospective analysis was performed in the 33 children with craniopharyngiomas treated by microsurgical technique through the transorbital subffontal approach. Results Total removal was performed in 30 patients （63%）, subtotal removal in 3 who underwent the stereotaxic radiotherapy after surgery, All patients had good clinical results, without operative mortality and severe complications. The follow-up in 31 cases ranged from 17 months to 8.1 years, averaging 4.8 years, of which 28 cases had a good prognosis and the others could not live without assistance. MRI/CT re-examination demonstrated there was no recurrence of craniopharyngiomas. Conclusion Microsurgical resection is an effective method against children craniopharyngiomas, and the transorbital subffontal approach can better the surgical outcomes because of the shorter distance to the tumor.