松果体区肿瘤的手术治疗（附158例报告）

Radical surgical treatment of pineal region tumors： report of 158 cases

目的探讨松果体区肿瘤的手术治疗策略和技术要点。方法对采用枕部经小脑幕入路切除的158例松果体区肿瘤患者进行回顾性研究，总结分析其临床资料、手术方法及术后随访结果。结果肿瘤全切除137例，次全切除19例，部分切除2例。病理证实生殖细胞肿瘤83例，松果体实质肿瘤18例，神经上皮肿瘤29例，其他类型肿瘤28例。术后死亡3例（1．9％），出现同向偏盲、眼球运动障碍等永久性并发症29例（18．4％）。19例出现早期或迟发性脑积水。结论手术切除是松果体区肿瘤的必要治疗手段，合理的手术入路、对松果体区蛛网膜及深静脉系统的深入了解以及娴熟的显微操作技巧，是保障手术安全有效的关键因素。

Objective To investigate surgical strategies and key techniques of pineal region tumors. Methods The records of 158 patients with pineal region tumors surgically removed by occipital transtentorial approach, including their clinical data, surgical methods and follow - up results, were retrospectively reviewed. Results A gross total tumor removal was accomplished in 137 patients （86. 7% ）, subtotal in 19 （ 12. 0% ）, and partial in 2 （ 1.3% ）. The histological diagnosis was germ cell tumor in 52.5%, pineal parenchymal tumor in 11.4%, glioma in 18.4% and miscellaneous in 17.7%. The mortality and permanent morbidity were 1.9% hydrocephalus occurred in 19 cases. Conclusions and 18.4%, respectively. Early or delayed Radical surgery plays an important role in the management of pineal region tumors. Reasonable approach selection, developed knowledge about arachnoid membranes and deep veins in pineal region, and skilled microsurgical techniques are critical to achieve a safe tumor removal.