经基底纵裂间入路治疗鞍区肿瘤

Surgical treatment of tumors in sellar region through transbasal interhemispheric approach

目的 探讨经基底纵裂间入路治疗鞍区肿瘤的效果.方法 对15例鞍区肿瘤患者,采用经基底纵裂间入路,对手术效果进行分析总结.结果 15例患者肿瘤全切,1例颅咽管瘤患者因高渗性缺水,出院后死亡,2例颅咽管瘤患者纠正高渗性缺水后正常出院.1例颅咽管瘤患者术后半年有复发迹象,行γ-刀治疗,其余患者无复发,术后无颅内感染及脑脊液鼻漏发生,术后不影响美观.结论 经基底纵裂间入路,手术视野广泛,向上可以进入第三脑室,向后可显露中脑导水管,向下可进入鞍内,应用范围广,手术效果好.

Objective To explore the surgical therapeutic efficacy of tumors in sellar region through transbasal interhemispheric approach. Method Fifteen sellar region tumor cases was treated through transbasal interhemispheric approach from January 2008 to May 2009. These cases included four craniopharyngiomas, four tuberculum sellae meningiomas, three olfactory grave meningiomas, two nofunction pituitary adenomas,one stalk hypophysial abscess and one frontal lobe glioma. The first symptom of ten cases was disturbance of vision or field of vision,four headace,one insipidus. All the fifteen cases underwent head MRI before and after operation. The diameter of the biggest tumor was 5 cm. All the tumors located around sellar region and grew upward. Result Total resection was achieved in all cases. Hyperosmotc dehydration was observed in 3 patients after operation. One craniopharyngioma patient died after leaving hospital because of electrolyte disturbance. Two craniopharyngioma patients leaved hospital normally after the electrolyte disturbance had been corrected. The original symptoms of rest cases were relieved and there was no nervous dysfunction. One craniopharyngioma patient received Gamma knife radiosurgery after operation because of tumor recurrence. There was no recurrence in the rest cases. There was no intracranial infection or cerebrospinal fluid rhinorrhea. The facial outlook wasn＇t affected. Conclusions Transbasal interhemispheric approach could provide much more surgical visible angle. Through this approach the third ventricle chould be reached ,the midbrain aqueduct chould be revealed backward and sellar region downward and better outcome of surgery chould be achieved.