经胼胝体-穹窿间入路显微手术切除第三脑室和松果体区肿瘤并行终板造瘘术的疗效分析

Removal of tumors in the third ventricle and pineal region by transcallosal-interfornix approach and termi-nal-ostomy

目的探讨经胼胝体-透明隔-穹窿间入路显微手术方法切除第三脑室和松果体区肿瘤并行终板造瘘术的疗效,讨论显微解剖学的理论基础。方法对经胼胝体-透明隔-穹窿间入路显微手术切除第三脑室和松果体区肿瘤并行终板造瘘术29例患者的临床资料进行回顾分析。结果 29例在手术显微镜下行肿瘤全切除13例,次全切除7例,部分切除9例。均在处理完肿瘤后行终板造瘘术。结论经胼胝体-透明隔-穹窿间入路手术切除第三脑室和松果体区肿瘤系通过胚胎组织残留的透明隔间隙进入第三脑室,正常组织损伤极少,可在直视操作下切除第三脑室及松果体区肿瘤,肿瘤全切除或次全切除率高,对于未做肿瘤全切除及考虑术后局部组织肿胀或放疗期间局部肿胀致导水管开口梗阻者,可同时行终板造瘘术,以解决脑积水问题。

Objective To assess the advantages of the transcallosal transpeUucidal interforniceal approach with terminal-ostomy in removal of tumors in the third ventricle and pineal region, and describe the microanatomy applied in this approach. Methods The clinical data of 29 patients who underwent micresurgical removal of neoplasms in third ventricle and pineal region with transcaUosal transpellucidal interforniceal approach and terminal-ostomy, between June 2008 and June 2011 were retrospectively analyzed. Results Of 29 patients, total removal of tumors was achieved in 13 patients, subtotal removal in 7 patients; partial removal in 9 patients respectively. After removal of tumors, terminal-ostomy were performed in all 29 patients. Conclusion TranscaUosal transpellucidal inter-forniceal approach is commonly described as the preferred route for neoplasms involving the third ventricle and pineal region. The major advantages afforded by the transcaUosal transpellucidal interforniceal approach include minimally disturbing the intracranial anatomy,the directly working corridor and morely removal of neoplasms. When the tumor cannot be entirely removed with this approach and germinoma verified by pathology result, the terminal-ostomy for a length between 5 and 7 mm, is executed to resolve hydrocephalus.