侧脑室内肿瘤显微外科治疗:29例报告

Microsurgical treatment of lateral ventricle tumors:report of 29 cases

目的探讨按肿瘤起源决定侧脑室内肿瘤手术入路的经验。方法回顾性分析自2002年1月至2009年1月在我院接受手术治疗的29例侧脑室内肿瘤患者的临床资料。其中15例采用经皮层入路,14例采用经纵裂入路。结果 23例肿瘤全切除,6例次全切除。病理证实良性肿瘤14例,低级别胶质瘤8例,高级别胶质瘤5例,恶性肿瘤2例。经皮层入路组患者术后癫痫发病率明显高于经纵裂入路组。平均随访时间为18.5个月,58.62%恢复良好。结论经纵裂胼胝体入路是治疗侧脑室内肿瘤较理想的手术入路,但对于肿瘤较大或肿瘤向脑实质延伸者或继发性脑室内肿瘤经皮层入路是较好的选择。肿瘤应争取全切,但不可强求全切,残留部分可进行放疗和(或)化疗。

Objective To discuss the surgical strategy of lateral ventricular tumors according to the tumor origin.Methods A total of 29 patients underwent the surgery on lateral ventricle tumors at our hospital from 2002 to 2009 were retrospectively studied,including 15 patients via transcortical approach and 14 patients via transcallosal approach.Results Total resection was performed in 23 patients and subtotal resection in 6 patients.Pathological examination confirmed 14 cases of benign tumors,8 cases of low-grade gliomas,5 cases of high-grade gliomas and 2 cases of malignant tumors.The ratio of postoperative epilepsy in the transcortical group was significant higher than that in the transcallosal group.The mean follow-up period was 18.5 months and 58.62% of patients achieved good recovery.Conclusion The transcallosal approach is preferred for the surgery of lateral ventricular tumors.The transcortical approach is a better option for the patients with transependymal involvement,or large primary or secondary ventricular tumors.The tumors should be resected as much as possible.But for the tumor remnants which can not be resected by surgery,radiotherapy or/and chemotherapy is recommended.