囊性颅咽管瘤内置管囊小剂量多次化疗的疗效观察

Treatment of cystic craniopharyngiomas by CT-guided stereotactic neuroendoscopic resection and intratumoral chemotherapy.

目的 探索神经外科综合治疗位于视丘下部附近区域的囊性颅咽管瘤之方法。方法 选择 16例囊性或以囊性为主的颅咽管瘤 ,在CT介导立体定向内窥镜下切除部分囊壁或肿瘤实质 ,排除囊液减压后囊内置入Ommaya管 ,术后经反复抽吸囊液 ,并反复注入小剂量博来霉素 30～ 40次。结果 16例经治疗后视力、视野障碍明显好转 ,7例有颅内压增高者术后缓解。CT显示瘤腔缩小 ,无手术死亡 ,术后视丘下部功能紊乱反应轻。 14例获随访 2～ 3年 ,临床症状明显改善。结论 该疗法安全、简便、有效 ,是采用微侵袭神经外科手段治疗颅咽管瘤的有效方法 。

Objective To investigate the treatment of cystic craniopharyngiomas by CT guided stereotactic neuroendoscopic resection and intratumoral chemotherapy. Methods 16 cases of cystic craniopharyngiomas were partial resected by CT guided stereotactic neuroendoscopy. Intratumoral chemotherapy with bleomycin were given postoperatively. Results The clinical symptoms improved promptly after evacuations of cyst in all patients. No death or severe complications occurred. Follow up (ranged from 2 to 3 years) CT or MRI indicated that the tumor cysts gradually regressed or disappeared. Conclusions The treatment of CT guided stereotactic endoscopic resection and intratumoral chemotherapy for cystic craniopharyngioma is safe and effective, which should be a very useful procedure in clinical practice.