大型中枢神经细胞瘤小切口手术探讨

Surgical removal of large central neurocytomas with small incision approach

目的探讨采用小切口经纵裂-胼胝体入路手术治疗幕上脑室内大型中枢神经细胞瘤的手术策略及技巧,以期减少手术创伤、提高手术疗效。方法与结果回顾6例经小切口纵裂-胼胝体入路行肿瘤全切除术的幕上脑室内中枢神经细胞瘤患者的临床资料与治疗经过。术后3例出现短暂性缄默、1例单侧肢体肌力减弱,均经营养神经治疗于2周内痊愈;1例失访、5例随访6个月至2年无复发。结论经小切口纵裂-胼胝体入路可利用颅内自然解剖间隙进行手术操作,路径最短,脑组织损伤最小;手术全程视野清楚,利于辨清和保护周围重要解剖结构;小切口手术可减少脑组织无效显露及术中出血,缩短开关颅时间,患者术后恢复快;与正常手术切口相比,未增加手术难度,是切除幕上脑室内中枢神经细胞瘤较为理想的入路。

Objective To investigate the strategy and technique of small incision surgery through interhemispheric transcallosal approach for removal of large central neurocytomas in supratentorial ventricule. Methods Clinical data and therapy of 6 cases with central neurocytomas were retrospectively studied. All tumors were removed through small incision interhemispheric transcallosal approach, and the clinical data were analyzed. Results Total resection was achieved in all cases. Three cases experienced transient mutism and one case experienced hemiparalysis. All of them received nerve-nurturing treatment and recovered within 2 weeks. Five cases were followed-up from 6 months to 2 years and there was no recurrence. Conclusions The advantages of interhemispheric transcallosal approach include provision of sufficient surgical visual field and space, protection of normal brain tissue by natural cavity and shortest surgical pathway. Small incision surgery may not only reduce invalid brain exposure and hemorrhage during operation, but also decrease operation time. The small incision surgery through interhemispheric transcallosal approach is an effective choice for removal of central neurocytomas involved in supratentorial ventricule.