颅咽管瘤全切术中的下丘脑功能保护

Preservation of hypothalamic function in total removal of craniopharyngioma

目的探索手术全切颅咽管瘤的有效方法。方法３０例颅咽管瘤病人中，２８例病人在全麻下行翼点入路，２例额下入路，视交叉前间隙切除肿瘤；结果除１例二次手术病人近全切除外，２９例均达到肿瘤全切。术后２７例参加日常工作，１例需要生活照顾，２例死亡，其中１例死于尿崩症，１例因误吸死亡。结论 术中保护下丘脑神经结构和避免其细小穿通动脉的损伤，对安全切除鞍上和三脑室内颅咽管瘤起重要作用。

Obiective To study the better method of surgical management of craniopharygioma MethodsIn 30 patienrs with craniopharyngioma,the pterional approach was performed in 28 patients, subfrontal approach in 2patients,The tumor was dissected in the parachiasmal, opticocarotic,carotidotentorial spaces and opening laminal terminals Great attention was paid to the presservation of the perforating arteries from the internal carotic,posterior andanterior communication an anterior choroidal arteries to the structure of the hypothalamus and the avoidomce of the hypothalamus injury. The solid portion of the tumor was removed with Piecemeal piecemeal after the cyst ftuid aspirated. Re-sults Total removal of the tumor were achieved in 29,patients, and subtotalremoval in one patient with secondsurgery. Follow up of all cases, 27patients had a normal life, one patient need assistance. One died from inhalation asphy xia 7 days for surgery, and other died of the complication of diabetes insipidus Conclusions.Many different surgical approaches can be used in the treatment of carniopharyngioma,according to the localization and extension Of the tumor. However, avoidance of the neural structures injury surrounding third ventricle and preservation of the perforating arteries to hypothalamus could be the key to achieve a good surgical result