胼胝体-穹窿间入路显微手术切除第三脑室肿瘤

Microsurgery through Transcallosal Interforniceal Approach for Tumors in the Third Ventricles

目的探讨经胼胝体-穹窿间入路显微手术切除第三脑室肿瘤的方法及疗效。方法胼胝体-穹窿间入路显微手术切除第三脑室肿瘤6例,其中突入第三脑室颅咽管瘤2例,丘脑胶质瘤1例,下丘脑错构瘤1例,畸胎瘤1例,松果体区生殖细胞瘤1例。结果本组4例肿瘤镜下全切,2例次全切除,无死亡病例。术后出现多饮、多尿、电解质紊乱3例,中枢性高热1例,嗜睡2例,经处理后1～2周消失;1例上视不能,3月后恢复;硬膜下积液3例,3月后自行吸收。结论胼胝体-穹窿间入路按生理间隙进入,直视下操作,对周围重要结构损伤很小,可切除第三脑室前、中、后各部位肿瘤,肿瘤全切除率高,并发症少。

Objective To explore the microsurgical skills for removing the tumor in the third ventricle. Methods The tumors were removed by microsurgery through transcallosal interforuiceal approach in 6 patients with the third ventricle tumors, which included 2 cases of craniopharyngiomas intruding into the third ventricles, 1 thalamic glioma, 1 hypothalamic hamartoma, I teratoma and lpineal germinoma. Results Total removal of the tumors was achieved in 4 cases and subtotal in 2. No death occurred in all the patients. The recent complications which disappeared one or two weeks after the management included polydipsia, diuresis and electrolyte disturbances in 3 cases. One patient with the Parinaud＇s syndrome recovered from his disease 3 months after the operation. The subdural effusion were spontaneously absorbed in 3 patients 3 months after the surgery. Conclusions Microsurgery thro.ugh transcallosal interforniceal approach can remove the tumors located in all the regions of the third ventricle and only produces a slight damage to the important structures around the tumors, and few complications occurred due to reaching the third ventricle through intracerebral physiological spaces, quite large operative field and intuitive operation.