囊性脑肿瘤的诊断与显微手术治疗

Microsurgical resection of cystic brain tumors

目的总结显微手术治疗颅内囊性肿瘤的手术技巧及经验，以期提高颅内囊性肿瘤的手术疗效。方法回顾性分析吉林大学第一医院神经外科自2003年8月至2010年8月手术治疗的47例颅内囊性肿瘤，所有患者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22例，囊性脑膜瘤8例，囊性恶性脑膜瘤3例，囊性室管膜瘤4例，血管网织细胞瘤4例，囊性脑转移瘤6例。根据肿瘤部位选择合适骨瓣开颅，于显微镜直视下手术。结果显微外科手术后经影像学复查，全切31例（65．96％），次全切除16例（34．04％），无手术死亡病例。术后近期出现神经功能障碍6例（12．77％），其中三叉神经、外展神经损害各1例，面神经功能障碍1例，舌咽神经损害1例，肢体瘫痪2例；术后脑积水2例。随访41例，随访期0．5-6年，8例（17．02％）复发，死亡2例，其余存活良好。结论显微外科手术能提高囊性脑肿瘤全切率，减少损伤，有效保护神经功能。

Objective To discuss the microsurgical resection of intracranial cystic tumors. Methods From August 2003 to August 2010, 47 patients who had been diagnosed by imaging with intracranial cystic tumor received microsurgical resection. The tumors were confirmed by pathological examination postoperation. There were 22 cases of cystic glioma, 8 cases of cystic meningioma, 3 cases of malignant cystic meningioma, 4 cases of cystic ependymoma, 4 cases ofangioreticuloma and 6 cases of cystic metastatic tumor. When the skull was minimally opened according to the location of the tumor, the hydatid fluid was absorbed before separation and resection of the tumor with its capsule under endoscopy. Results Total resection was performed in 31 cases （65.96%） and sub-total resection in 16 cases （34.04%）. No operative death occurred. Neural dysfunction was observed not long postoperation in 6 cases （12.77%）, including one case of trigeminal nerve injury, one case of abducent nerve injury, one case of facial nerve dysfunction, one case of glossopharyngeal nerve injury, 2 cases of paralysis and 2 cases of hydrocephalus. Forty-one patients were followed up for 0.5 to 6 years. Eight patients （17.02%） had recurrence and 2 died. Conclusion Microneurosurgery can improve the total resection rate of intracranial cystic tumors with minimal invasion to neural functions.