松果体区肿瘤的显微外科治疗(附62例报告)

Microsurgery for pineal region tumors: report of 62 cases

目的探讨松果体区肿瘤的显微手术方法和技术要点。方法总结62例松果体区肿瘤病人的手术经验。其中行经纵裂胼胝体后部入路6例,侧脑室后部入路3例,枕部小脑幕入路42例,幕下小脑上入路10例,幕上下联合入路1例。结果肿瘤全切除52例(83.9%),次全切除8例(12.9%),活检2例(3.2%)。手术后辅助放疗33例,脑脊液分流2例。术后恢复良好55例(88.7%),学习工作能力差6例(9.7%),死亡1例(1.6%);随访期间肿瘤复发4例(6.5%)。结论松果体区良性肿瘤手术治疗效果好,恶性肿瘤亦可通过手术切除治愈或提高辅助治疗效果。合理的手术入路、娴熟的显微外科技术及熟练掌握颅底显微解剖是手术成功的关键。

Objective To explore the methods and technical notes of microsurgery for pineal region tumors. Methods Our operative experience in treating 62 patients with pineal region tumors was summarized. Posterior transcallosal approach was adopted in 6 cases, posterior transventricular in 3, occipital-transtentorial in 42, infratentorial-supracerebellar in 10, and supratentorial combined with infratentorial in 1. Results Tumor was totally resected in 52 cases （83.9%）, subtotally in 8 （12.9%）, and biopsy was done in 2 （3.2%）. Adjuvant irradiation therapy was performed in 33 cases, and ventriculo-peritoneal shunting in 2 after the surgery. After the operation, 55 patients （88.7%） recovered well, 6 （9.7%） had a lowered ability to work and learn, and 1 （1.6%） died. Four patients （6.5%） showed delayed recurrence during follow-up. Conclusion Surgical removal is effective for benign tumors of pineal region and resection can be curative or improve the efficacy of adjuvant therapies for malignant tumors. Adequate approach, skillful microsurgical techniques and good understanding of microanatomy of the skull base are the keys to success of the surgery.