神经内镜辅助显微手术治疗囊性脑肿瘤的疗效观察

Treatment of cystic brain tumor with neuroendoscope-assisted microneurosurgery

[目的]总结显微直视手术颅内囊性肿瘤中辅以神经内镜处理显微镜死角区肿瘤的经验,以期提高颅内囊性肿瘤的全切率。[方法]回顾性分析2003年8月-2010年8月手术治疗的颅内囊性肿瘤病例49例,所有病例术前均行影像学检查并经手术及病理证实。其中囊性脑胶质瘤21例,囊性脑膜瘤11例,囊性室管膜瘤4例,血管网织细胞瘤3例,囊性脑转移瘤6例,表皮样囊肿4例。根据肿瘤部位选择合适骨瓣开颅,先于显微镜直视下分离切除肿瘤及其囊变与包膜,后用神经内镜观察显微镜盲区域是否有肿瘤残留,并于神经内镜下切除。同时以1996年8月-2003年7月未用神经内镜辅助手术的颅内囊性肿瘤51例作为对照组,进行对比分析。[结果]神经内镜辅助手术组术后经影像学复查,全切43例(87.76%),大部切除6例(12.24%);术后近期出现神经功能损害症状者5例(10.20%);无手术死亡。获随访38例,随访期0.5～6年,均恢复正常工作学习。对照组全切34例(66.67%),大部切除17例(33.33%),近期出现神经功能损害者7例(13.73%),死亡2例。神经内镜辅助组全切率与对照组比较,差异有显著性意义(P<0.05),而两组间术后神经功能损害等并发症发生率差异无显著性意义(P>0.05)。[结论]颅内囊性肿瘤显微直视手术中,辅以神经内镜可以观察并切除显微镜死角区的残余肿瘤,从而提高手术全切率,有效防止肿瘤复发。

[ Objective ] To evaluate clinical practice of tumor resection at blind angle by microsurgery under direct vision combined with neuroendoscopy in order to improve the total resection rate of intracranial cystic tumor. [ Methods] A retro- spective analysis of 49 patients with intracranial cystic tumors, which were confirmed by operation and pathological exami- nation and treated by neuroendoscopic microsurgery from August 2003 to August 2010 was performed, in which there were 21 cases of cystic cerebral glioma, 11 cases of cystic meningeoma, 4 cases of cystic ependymoma, 3 cases of angioreticulo- ma, 6 cases of cystic brain metastasis tumor, and 4 cases of epidermoid cyst. Proper craniotomy was performed according to the position of lesions, and the tumor and cystic lesions were resected under direct vision. For comparison, 51 cases with intracranial cystic tumor operations without neuroendoscopy from August 1996 to July 2003 were taken as the control group. [ Results] According to postoperative imaging, in the neuroendoscopic group there were 43 cases of total resection （87.76%）, 6 cases of mostly resection （ 12.24% ）, 5 cases of neurologic dysfunction （ 10.20% ）. There was no death caused by operation. Thirty - eight cases were followed up for 0.5 - 6 years and they all returned to normal. While in the control group, there were 34 cases of total resection （66.67%）, 17 cases of mostly resection （33.33%） ,7 cases of neu -rologic dysfunction （ 13.73% ） and 2 cases of death due to operation. There was difference between neuroendoscope - as- sisted and the control group in total removal rate （ P 〈 0.05 ）, and the incidence of complications such as postoperative neu- rological dysfunction between the two groups had no difference （P 〉 O. 05 ）. [ Conclusion ] The residual tumor in blind ar- ea of intracranial cystic tumors could be totally resected by microsurgery under direct vision combined with neuroendoscopy with a higher total resection rate and a lower tumor recurrence rate.