成人单侧丘脑胶质瘤手术技术探讨

Surgical techniques of unilateral thalamic gliomas in adults

目的明确如何根据单侧丘脑胶质瘤的解剖位置及生长方向指导手术入路的制定，并探讨相应手术技巧及辅助技术。方法回顾性分析2004年1月至2012年6月于我院手术治疗的98例成人单侧丘脑胶质瘤病例资料。53例为低级别胶质瘤，45例为高级别胶质瘤。其中主体基本位于单侧丘脑的胶质瘤81例；主体位于单侧丘脑并向中脑生长的胶质瘤17例。全部病人均行手术切除。结果肿瘤全切为62例（63％），次全切为26例（27％），大部切除为10例（10％）。肿瘤切除术后短期症状明显改善61例（62％），症状无变化29例（30％），症状恶化6例（6％），死亡2例（2％）。结论对于单侧丘脑胶质瘤，选择适合的手术入路、正确的手术技巧，并使用相应术中辅助技术，多数病人能获得显微镜下手术全部切除或次全切除以及良好的手术质量。

Objective The aims of this study were to determine how to choose the appropriate surgical approach based on the anatomical character of the thalamic gliomas and to investigate the corresponding surgical skill and assistive technology. Methods The records of 98 adult patients with thalamic tumor between 2004. 1 and 2012. 6 in our hospital were retrospectively reviewed. Of the 98 patients, 53 had a low - grade tumor, and 45 had a high - grade tumor. Two groups of gliomas were analyzed separately： （1） unilateral thalamic gliomas （81 lesions）; （2） thalamopednncular gliomas （17 lesions）. All the patients underwent tumor resection. Results Total resection of the tumor was achieved in 62 cases （63%）, subtotal resection in 26 （27%） cases and most resection in 10 （10%） cases. Postoperative improvement was achieved in 61 cases （62%） , unchange in 29 （ 30% ） cases, aggravation in 6 （ 6% ） cases, and death in 2 （2%） cases. Conclusions Total or subtotal remove and good results can be gained in the majority of the patients with unilateral thalamic gliomas based on the correct surgical approach, skill and assistive technology.