46例颅咽管瘤显微外科治疗及预后影响因素分析

Craniopharyngioma: An Analysis of Microsurgery and Factors Influencing Prognosis

目的:探讨颅咽管瘤手术入路,影响全切除的因素及术后并发症的防治。方法:回顾性分析本院1995年1月至2005年1月颅咽管瘤手术病例46例。主要临床表现为头痛、视力视野障碍、下丘脑功能障碍、尿崩症。分别采用经翼点20例(43.5%)、经额下12例(26.1%)、经胼胝体-透明隔间腔-穹隆间入路3例(6.5%),经前额纵裂入路5例(10.9%),经额叶皮层造瘘-侧脑室室间孔入路2例(4.3%)、翼点联合侧脑室室间孔入路4例(8.6%)切除肿瘤。结果:全切除+次全切除31例(67.4%)、大部切除15例(32.6%),围手术期死亡1例(2.2%)。术后并发症主要为尿崩症、血电解质紊乱及癫痫。结论:选择恰当的手术入路、术者娴熟的显微神经外科技术及术中对下丘脑及重要穿支血管的保护、术后并发症积极防治是影响颅咽管瘤预后的关键因素。

Objective： To investigate the surgical approaches for treating craniopharyngiomas, the factors influencing total resection and the prevention of complications. Methods： From January 1995 to January 2005, 46 cases with craniopharyngioma underwent microsurgery. Major clinical manifestations included headache, vision and visual field disorders, hypothalamic dysfunctions and diabetes insipidus. Various approaches were used to remove the lesions, including the pterional approach in 20 cases （43.5%）, the subfrontal approach in 12 cases （26.1%）, the transcallosum interfornix approach in 3 cases （6.5%）, the transfrontal longitudinal fission approach in 5 cases （10.9%）, and the frontal cortical- transventricular lateral cerebral-ventricle interventricular-foramen approach in 2 cases （4.3%）. Results： Total or subtotal resection was performed in 31 cases （67.4%）, and partial removal was performed in 15 cases （32.6%）. Perioperative death with incidental hypothalamic injury occurred in 1 case （2.2%）. Major postoperative complications included diabetes insipidus, blood electrolyte disorder and epilepsy. Con- clusions： The correct selection of the operative route, skillful microneurosurgical technique and intraoperative protection of the hypothalamus and its basilic perforating-branch blood vessels, as well as the active postoperative prevention of complications are all key factors influencing the prognosis of craniopharyngioma.