复发颅咽管瘤的显微手术治疗

nicrosurgical resection of recurrent craniopharyngiomas

目的探讨复发性颅咽管瘤的手术治疗方法和技巧。方法回顾性分析15例复发性颅咽瘤患者的临床资料。其中男10例，女5例；年龄10～56岁。手术采用原切口入路13例（翼点入路10例，额下入路3例），经纵裂胼胝体入路1例，联合入路1例。结果肿瘤全切除9例，近全切除5例，大部切除1例。术中垂体柄保留6例，断离4例，未见垂体柄5例；术后大多数患者的视力改善，单眼失明1例；尿崩12例，电解质紊乱7例；垂体功能低下6例；癫痫3例；无死亡。结论复发性颅咽管瘤与其周围结构关系紊乱、粘连重或钙化，但手术切除仍然是可行的治疗方法。

Objective To study the effective methods and skills of microsurgical resection for recurrent craniopharyngiomas. Method From 2001 to 2006, microsurgical resection was performed in 15 cases with the recurrent craniopharyngiomas composed of 10 men and 5 women, whose age ranged from 10 to 56 years old （mean age 32.3 years）. The prior surgical approach was employed in 13 cases（ 10 cases with pterional approach and 3 cases with subfrontal approach ） and transcallosal interfornical approach in 1 case and the combined approach in 1 case, respectively. Results Total removal of the tumors were completed in 9 cases, subtotal removal in 5 cases, and partial removal in 1 case. The pituitary stalk was preserved in 6 cases, severed in 4 cases and not identified in 5 cases during surgery. In most cases, visual function was preserved or improved, 1 case became blind, 12 patients experienced diabetes insipidus and 7 cases occurred electrolyte disturbances, 6 patients had the hypothalamic hypofunction after surgery, and 3 cases suffered epilepsy, no death occurred. Conclusions Surgery can still be a major therapeutic option in the management of recurrent craniopharyngiomas, although the reoperation of the tumors was performed very difficultly owing to the tumor adhesion to the surrounding hypothalamic structures.