神经内镜在囊性颅咽管瘤治疗中的作用

Role of neuroendoscopy in treatment of the cystic craniopharyngiomas

目的 探讨神经内镜在巨大囊性颅咽管瘤治疗中的作用。方法 对巨大囊性颅咽管瘤伴有梗阻性脑积水的 9例患者 ,应用神经内镜先缩小肿瘤体积、解除梗阻性脑积水并穿通囊内分隔 ,之后再辅以放射或显微手术切除。结果 9例患者术后颅内压增高症状均消失、术前症状改善。影像学复查 (CT或MR)见肿瘤均缩小至鞍区、脑积水消失。除 1例有暂时多尿及低钠外 ,余无其他严重并发症。再手术全切除肿瘤的 3例患者术后反应明显减轻。结论 对有囊性变并伴有脑积水的巨大颅咽管瘤 ,先采用神经内镜手术 ,是提高进一步治疗效果。

Objective To investigate the role of neuroendoscope in treatment of the large cystic craniopharyngiomas. Methods Neuroendoscope was firstly applied to shrink the volume of the tumors, obliterate obstructive hydrocephalus, and canalize the intervals of the cysts in 9 cases of large cystic craniopharyngiomas accompanied with obstructive hydrocephalus, Then, the tumors were treated with radiotherapy or microsurgical resection. Results Symptoms of intracranial hypertension disappeared and other symptoms improved after surgery in all 9 patients. Imagings(CT or MR) showed that the tumors shrinked to sellar region and hydrocephalus disappeared. There didnt exist severe complications except 1 patient with transitory polyuria and hyponatremia. Postoperative responses were obviously abated in 3 cases with total resection. Conclusions Neuroendoscope is an effective way to improve curative effect, decrease morbidity and mortality in patients with large cystic craniopharyngiomas accompanied with hydrocephalus.