枕下经小脑幕入路松果体区肿瘤切除术后脑积水的处理

Treatment of hydrocephalus after tumorectomy in the pineal region via infratentorial supracerebellar approach

目的总结枕下经小脑幕入路松果体区肿瘤切除术后产生脑积水的原因及处理经验。方法对11例术后脑积水病人的临床资料进行总结分析。8例脑积水出现在术后2周以内,定为早期脑积水,其中7例进行脑室外引流,引流时间5～8d;3例脑积水出现在术后2周以上的放疗期间,定为迟发性脑积水,均行脑室镜下第三脑室底造瘘术。结果松果体区肿瘤术后脑积水病人占同期松果体区肿瘤手术的16.2%。7例经脑室外引流治疗的早期脑积水病人恢复良好,拔除外引流管后无需内引流;1例未行脑室外引流者死亡。3例迟发性脑积水病人症状均缓解,继续放疗,完成计划的照射剂量。结论松果体区肿瘤术后脑积水是常见并发症。早期脑积水的主要原因系静脉损伤性脑肿胀,多为暂时性;迟发性脑积水系局部黏连所致,需手术治疗。

Objective To summarize the causes and experiences about treatment of hydrocephalus after tumorectomy in the pineal region via infratentorial supracerebellar approach （Krause approach）. Methods Clinical data from 11 cases of hydrocephalus after tumorectomy in the pineal region via Krause approach were analyzed and summarized. Hydrocephalus was divided into early-stage group with 8 cases in which hydrocephalus occurred in 2 weeks after the operation and delayed group with 3 cases in which hydrocephalus occurred 2 weeks later. Seven cases of early stage hydrocephalus received external ventricular drainage for 5 to 8 days. All of the 3 delayed cases were operated for ostomy under ventriculoscope. Results Incidence rate of hydrocephalus after tumorectomy in the pineal region was 16.2%. Seven early stage cases treated with external ventricular drainage recovered well without internal drainage after the drainage tube was pulled out, and the one who was not treated by external ventricular drainage died. All the 3 delayed cases had symptomatic relief with continued radiotherapy to accomplish the planed irradiation dose. Conclusion The hydrocephalus is a common complication of tumorectomy in the pineal region. Early stage hydrocephalus is caused mainly by venous injured brain edema, and was temporary, and delayed hydrocephalus is due to focal adhesion, which needs to be operated.