Poppen入路显微手术治疗松果体区肿瘤

Microsurgical treatment of the tumor in the pineal region through Poppen approach

目的总结经Poppen入路显微手术治疗松果体区肿瘤的经验。方法回顾性分析32例松果体区肿瘤的临床资料,均采用显微手术切除,其中经左侧Poppen入路21例,右侧Poppen入路11例,并同时采用分流术和(或)引流术处理脑积水。结果肿瘤全切除25例,次全切除4例,部分切除3例。经病理检查:良性肿瘤12例,恶性肿瘤20例。术后并发硬膜外血肿3例,短暂性意识障碍加重1例,同向偏盲3例,视力下降加重3例,Parinaud综合征加重3例,复视加重3例。本组随访24例,时间1个月～3年,均复查MRI。正常生活13例,生活自理6例,生活需要照顾3例,死亡2例。多数病人临床症状不同程度改善。结论采用Poppen入路显微手术切除松果体区肿瘤效果良好,术中行脑室-枕大池分流术对于大多数非交通性脑积水病人是安全而必要的。

Objective To summarize the experiences of microsurgery treatment for the tumor in the pineal region via Poppen approach. Methods The clinical data of 32 patients with a tumor in the pineal region were analyzed retrospectively. The tumor was resected microsurgically via left Poppen approach in 21 cases and right Poppen approach in 11. The hydrocephalus was treated by bypass and/or drainage at the same time. Results The total tumor removal was achieved in 25 patients, subtotal in 4, and partial in 3. The tumors were benign in 12 patients and malignant in 20, which were confirmed by pathological examination. Postoperative complications such as epidural hematoma occurred in 3 cases, transient disturbance of consciousness being aggravated in 1, homonymous hemianopia in 3, hypopsia aggravated in 3, Parinaud syndrome worsened in 3 and diplopia worsened in 3. Twenty-four patients were followed up by MRI for 1 month to 3 years： 13 patients returned to their normal life, 6 had self-care ability, 3 needed to be taken care of and 2 died. The clinical manifestations improved to different degrees in majority of patients. Conclusions Microsurgical treatment of the tumor in the pineal region through Poppen approach can achieve good effect. Intraoperative lateral ventricule-cistema magna shunt is safe and necessary for the majority of patients with non-communicating hydrocephalus.