116例颅咽管瘤的显微手术治疗

Microsurgical treatment of craniopharyngiomas for 116 cases

目的探讨颅咽管瘤显微手术切除的方法和入路。方法116例经显微手术切除的颅咽管瘤中,有囊性变者64例,有钙化者58例,实质性52例,肿瘤直径2cm以下者14例,2.1￣4cm61例,4.1￣6cm31例,>6cm者10例。99例经右翼点入路,7例经胼胝体前入路,10例经翼点—胼胝体联合入路切除肿瘤。结果经术中观察和影像学资料证实,全切除106例,次全切除6例,大部切除4例。术后随访1月￣7年,能参加工作或学习者100例,需生活照顾者14例,死亡2例。结论颅咽管瘤早期诊断,显微手术全切除,效果理想。巨大、实质性肿瘤且伴有糖尿病者手术危险性较大,翼点入路是鞍区颅咽管瘤显微手术切除的最佳入路。

Objective To explore the microsurgical method and approach for radical treatment of craniopharyngiomas. Methods From 1997 to 2005, 116 patients of craniopharyngiomas were treated with microsurgical resection in our hospital. Cystic change of the tumors was found in 64 patients, calcification in 58 patients and solid tumors in 52 patients. The diameter of the tumor： 〈2 cm in 14 cases, 2.1～4 cm in 61 cases, 4.1～6 cm in 31 cases, 〉6 cm in 10 cases, 99 patients were operated via the right pterional approach, 7 patients via anterior transcallosal approach, and 10 patients via pterional-transcallosal approach. The follow-up of from I month to 7 years was performed on all patients, Results Total removals of tumors were achieved in 106 cases, and subtotal removal in 6 cases, most removal in 4 cases, 100 patients recovered to normal life and study, 14 patients lived a dependent life and 2 patients died, Conclusion Early diagnosis at the stage when the tumor is still small, improves the chances of accomplishing complete removal and achieving good operative result. Giant, solid tumors, if accompanied with diabetes, were more dangerous. The pterional approach may be the best way for total removal of craniopharyngiomas in sellar region, except the tumor grows in third ventricle.