前纵裂入路显微手术切除鞍上脑室内外型颅咽管瘤

Microsurgery resection of large craniopharyngioma through anterior interhemispheric approach

目的探讨前纵裂入路在鞍上脑室内外型颅咽管瘤显微手术切除中的应用，并比较与其他手术入路的优缺点。方法回顾性分析22例采用前纵裂入路显微手术切除鞍上脑室内外型大型颅咽管瘤患者，分析手术技巧及术后效果。结果肿瘤全切20例，次全切除2例，无手术死亡病例。术后发生电解质紊乱15例，尿量增多17例，2—7周后好转，术后1周内视力好转15例。随访6—60个月，肿瘤复发2例，均为12个月内复发。结论前纵裂入路可直视下处理肿瘤在垂体漏斗部位的粘连，是鞍上脑室内外型颅咽管瘤较好的手术入路。

Objective To explore the usefulness of anterior interhemispheric approach in microsurgical resection of craniopharyngioma located suprasellar and intraventricular area, the merit and demerit of this approach. Methods 22 cases of craniopharyngiomas surgically treated by anterior interhemispheric approach from Jan. 2007 to Dec. 2011 were retrospectively analyzed. Results Total removal of the lesion were achieved in 20 cases and subtotal removal in 2 cases. None of the patients died during follow - up. All patients received MRI scanning in 24 hours and demonstrated total resection. The electrolyte disturbances were shown in 15 cases, diabetes insipidus in 17 cases and recovery in 2 -7 weeks ,visual acuity improvement in 15 cases. Follow - up was conducted from 6 to 60 months, and 2 patients were found recurrence. Conclusions The anterior interhemispheric approach provides a safe and minimal invasive method to surgically treat giant craniopharyngioma located in suprasellar and anterior third ventricle.