外侧裂区胶质瘤的解剖特点及显微手术探讨

Anatomical Characteristics and Microsurgery of the Glioma Located in Lateral Fissure Area

目的探讨外侧裂区胶质瘤的解剖特点、影像学特征以及显微手术方法。方法回顾性分析46例外侧裂区胶质瘤患者临床资料,其中行肿瘤全切除30例,次全切除13例,部分切除3例。结果病理证实星形细胞瘤29例,多形性胶质母细胞瘤7例,少支胶质瘤10例。术后对侧肌力好转15例,加重4例。脑血管痉挛8例(致重度脑水肿6例),其中7例对症治疗后预后良好,1例脑梗塞致重残。暂时性失语和记忆减退4例。无手术死亡病例。41例平均随访18(3～36)月,35例存活,6例死亡(5例死于肿瘤复发,1例死于肺部感染)。12例平均于术后14(10～18)月复发。结论经外侧裂显微手术切除胶质瘤可显著提高肿瘤近全切率,减少术后神经功能障碍并发症,避免短期肿瘤复发。恰当的手术入路,对侧裂区动静脉及重要功能区的精确辨认和保护是提高疗效的关键。

Objective To investigate the anatomical characteristics,imaging features and microsurgical techniques of the glioma located in lateral fissure area.Method The clinical data of 46 patients suffered the lateral fissure gliomas were reviewed,including 30 of total resection 13 of subtotal resection and 3 of partial resection.Results Postoperative pathological results revealed that astrocytoma was in 29 cases,multiform glioblastoma in 7 cases and oligodendrogliomas in 10 cases.The myodynamia of contralateral limb improved in 15 and aggravation in 4 after operation.8 patients were found cerebral vasospasm,of which 6 combined with severe encephaledema.Out of the 8 patients,good prognosis was achieved in 7 cases after symptomatic treatment and severe disability associated with large area cerebral infarction in 1 case.There was transient alogia and hypomnesia in 4 cases.No one died during the perioperative period.41 cases were followed up for 3 to 36 months with an average of 18 months.35 patients survived,5 died of tumor relapse and 1 died of pulmonary infection.Among the 6 deaths,5 were multiform glioblastoma and 1 was astrocytoma with grade ⅠtoⅡ.12 cases relapsed in 10 to 18 months after operation.Conclusions Microsurgery can improve the total removal rate,reduce the complication incidence of neurological deficits and avoid short-term tumor recurrence in the treatment of the glioma located in lateral fissure area.The measures of proper selection of surgical approaches and precise identification and protection of the blood vessels are the keys to improve the operative effect.