儿童第三脑室室内型颅咽管瘤的显微手术治疗及术后并发症的防治

Pediatric intrinsic third ventricular craniopharyngiomas： microsurgical treatment and ,management of postoperative complications

目的探讨儿童第三脑室室内型颅咽管瘤显微手术治疗方法及术后并发症的防治方法。方法自2005年7月至2011年5月云南省第一人民医院神经外科共收治儿童第三脑室室内型颅咽管瘤患者18例，均采用胼胝体一透明隔一穹窿间人路进行手术切除，现回顾性分析该18例患儿临床资料、治疗效果及术后并发症的防治过程。结果肿瘤全切13例，近全切除3例，大部分切除2例。患者症状和体征均得到不同程度的改善。术后主要并发症为：尿崩（15／18）、血电解质紊乱（12／18）、中枢性高热（5／18）和癫痫（4／18），经积极防治后均得到控制，总体治疗效果良好。结论经胼胝体－透明隔－穹窿间入路是切除儿童第三脑室室内型颅咽管瘤的理想路径，积极防治术后并发症对改善患者预后意义重大。

Objective To investigate me mtcrosurgery and management of postoperative complications in pediatric patients with intrinsic third ventricular craniopharyngiomas. Methods From July 2005 to May 2011, 18 pediatric patients with intrinsic third ventricular craniopharyngiomas were treated by microsurgery via the transcallosal-interseptal-interfomix approach. The microsurgical procedures and management of postoperative complications were analyzed retrospectively. Results The tumors were totally resected in 13 cases, subtotally resected in 3 and partially resected in 2. The symptoms and signs of the patients were improved in varying degrees. The major postoperative complications included diabetes insipidus （15/18）, electrolyte disturbance （12/18）, central hyperthermia （5/18） and epilepsy （4/18）. The complications all responded to active managements. The global therapeutic outcomes were fine. Conclusions The resection via the transcal-losal-interseptal-interfomix approach is an ideal treatment of the pediatric intrinsic third ventricular craniopharyngiomas. Active management of postoperative complications is essential to a good prognosis of the patients.