侧脑室肿瘤切除的入路选择及显微手术技术

Skill and Selection of Approach of Microsurgery for Lateral Ventricular Tumors

目的探讨侧脑室肿瘤切除的手术入路及显微外科技术。方法对33例侧脑室肿瘤病例,7例经额叶皮质、4例经纵裂胼胝体、15例经顶枕叶皮质、7例经颞叶皮质入路,应用显微技术行肿瘤切除,并对患者的临床资料进行回顾性分析。结果肿瘤全切20例,大部分切除7例,部分切除6例。其中脑膜瘤16例,室管膜瘤10例,星形细胞瘤5例,脉络丛乳头状瘤2例。术后出现脑积水4例,肢体轻瘫4例,偏盲2例,远隔部位血肿1例,癫痫1例。随访时间4个月~6年,平均3.7年。18例术后恢复良好并参加工作,9例术后状况基本同术前（生活可自理）,不能生活自理2例,2例星形细胞瘤病人1年后肿瘤复发死亡,失访2例。结论采用显微神经外科技术,选择不同的手术入路切除侧脑室肿瘤可取得良好的临床效果。

Objective To explore the microsurgical skill and approaches in the patients with lateral ventricle tumors. Methods A retrospective analysis was performed in 33 patients with lateral ventricle tumors, of whom, 7 underwent the microsurgery through transfrontal cortrex approach, 4 through transcallosal approach, 15 through transparieto-occipital cortrex approach, and 7 through transtemporal cortrex approach. Results of 33 patients, 20 received total resection of the tumors, 7 subtotal resection and 6 partial resection. The pathological examination showed that of 33 tumors, 16 were meningiomas, 10 ependymomas, 5 gliomas, and 2 chroid plexus papillomas. The postoperative complications included hydrocephalus in 4 patients, hemiparesis in 4, hemianopia I n 2, intracerebral hematoma in 1 and epilepsy in 1. Of 31 patients followed up from 4 months to 6 years （mean, 3.7 years）, 18 were recovered very well, 9 could live without the other help, 2 lived with the other help and 2 died of tumor recurrence 1 year after the operation. Conclusion The curative effect of the skillful microsurgery through the proper approach on the patients with lateral ventricle tumors is good.