经蝶窦入路显微手术切除小儿颅咽管瘤

Transsphenoidal microsurgical treatment for pediatric craniopharyngiomas

目的 探讨经蝶窦入路切除小儿颅咽管瘤的手术技巧及适应证。 方法 10例接受了11次经蝶窦手术 ,10次采用唇下 -鼻中隔 -蝶窦入路 ,1次采用鼻外侧 -筛窦 -蝶窦入路 ,在 X线透视监测及显微放大 10～ 15倍下切除肿瘤 ,对未能全切除病例术后加后放疗 1个疗程。 结果 无死亡、无严重并发症 ,全切除 4例 ,次全切除 4例 ,部分切除 2例 ,其中 1例残瘤病例再次经蝶窦手术获得全切除。随访 3个月～ 9年 ,肿瘤消失 5例 ,残瘤静止 4例 ,1例复发。 结论 小儿颅咽管瘤局限于鞍内或伴蝶窦扩大的鞍内 -鞍上型可经蝶窦手术 ,但钙化明显的肿瘤经该入路难以获得令人满意的切除。

Objective To study operational techniques and indications of transsphenoidal microsurgery in the treatment of pediatric craniopharyngiomas Methods Ten patients underwent 11 transsphenoidal operations,including 10 sublabia transsphenoidal approach surgery C arm X ray and a microscope were used during surgery An after loading radiotherapy to the children without total resection was performed Results There was no surgical mortality,no severe complications 4 tumors were removed totally,5 tumors subtotally and 2 tumors partially One child underwent repeated transsphenoidal surgery for residual tumor After 3 months to 9 years follow up,5 tumors disappeared,4 residual tumors had no change and 1 tumor recurrent Conclusions Pediatric craniopharyngiomas located intrasellar or intrasellar suprasellar with enlarged sphenoidal sella can approached through the tanssphenoidal route It was difficult to remove the tumor with significant calcification through this route