经纵裂-胼胝体入路切除第三脑室病变的临床研究

Clinical application of transcallosal-hemispheres approaches to the third ventricle

目的探讨经纵裂．胼胝体入路切除第三脑室病变的临床应用。方法回顾性分析20例第三脑室病变患者均行经纵裂．胼胝体入路切除。结果经胼胝体-穹窿间入路切除第三脑室肿瘤20例，第三脑室前部肿瘤8例，中部10例，后部2例。肿瘤全切17例，次全切除2例，大部分切除l例。术后病理示：颅咽管瘤6例，胶样囊肿4例，生殖细胞瘤2例，星形细胞瘤2例，垂体腺瘤2例，室管膜瘤2例，脑膜瘤1例，畸胎瘤1例。术后出现多尿、多饮、电解质紊乱6侧，中枢性高热5例，经处理后1—2周好转出院；短期内记忆力障碍4例，3个月内均有所恢复；缄默症2例，1个月内恢复；脑积水3例，行脑室．腹腔分流术后恢复良好。结论经胼胝体一穹窿间入路操作简单，可直视下操作，此入路对周围比较重要的结构及组织损伤小，肿瘤切除率高，患者手术后并发症少、病死率低。是手术切除第三脑室病变的理想入路。

Objective To investigate the clinical application of transcallosal-hemispheres ap- proaches to the third ventricle. Methods Twenty cases of the third ventricle tumors were removed through corpus callosum approach, and the results were analysed. Results Twenty patients with the third ventricle tumors, 8 cases being located in the anterior portion of the third ventricle, 10 cases in the middle portion and 2 cases in the posterior portion, underwent tumor resection via transcallosal interforni- ceal approach. Total resection of the third ventricle tumors was achieved in 17 cases, subtotal resection in 2 cases and partial resection in 1 case. The pathological examination revealed 6 craniopharyngiomas, 4 colloid cysts, 2 germ cell tumors, 2 astrocytomas, 2 pituitary adenomas, 2 ependymocytomas, 1 meningi- oma and 1 teratoma. The postoperative complications included polyuria, polydipsia, electrolyte disorder in 6 patients, central high fever in 5 patients, all of them got improved and discharged after treated for 1 week to 2 weeks;short-term memory disturbance occurred and recovered within 3 months in 4 patients. Mutism appeared and recovered in one month in 2 patients. Three patients had hydrocephalus, all of them underwent ventriculoperitoneal shunt with good recovery. Conclusions The transcallosal-interforni- ceal approach permitted surgery directly, and the paired vital structures could be viewed clearly and they couldn＇ t be easily damaged, and the whole third ventricle could be adequately revealed. The approach is safe and direct, has the high resection rate, low postoperative complications and minimal mortality, so it is an ideal choice for the resection of third ventricle tumor.