第三脑室颅咽管瘤的手术治疗策略

Surgery strategies for the third ventricle craniopharyngioma

目的:总结第三脑室颅咽管瘤的手术治疗策略。方法:回顾性分析行手术治疗的28例第三脑室颅咽管瘤患者的临床资料,对比经终板和经前纵裂-胼胝体-透明隔-穹窿间2种手术入路的治疗效果和适应症。结果:2种手术入路在全切肿瘤率上无明显的统计学差异(P=0.907),经前纵裂-胼胝体-透明隔-穹窿间入路比经终板入路更容易出现尿崩(P=0.027)、电解质紊乱(P=0.033)等并发症。经终板入路适用肿瘤主体位于视交叉后上第三脑室底前部的肿瘤切除,而经前纵裂-胼胝体-透明隔-穹窿间入路适用于完全位于第三脑室内或肿瘤主体位于第三脑室内的肿瘤切除。结论:根据颅咽管瘤的影像学特征选择适当的手术入路,术中注意保护下丘脑和垂体柄是手术成功的关键。

Objective：To summarize the surgery strategies for the third ventricle craniopharyngioma. Methods：Clinical data of 28 patients treated in our hospital were retrospectively analyzed. The surgery effect and indications between lamina terminalis approach and the anterior interhemispheric fissure-corpus callosum-septum pellucidum-interforniceal approach were compared. Results：There was no significant statistical differences in the gross tumor resection rate between these two kinds of approaches（P=0.907）. The anterior interhemispheric fissure-corpus callosum-septum pellucidum-interforniceal approach had higher rate of post-operation complications as diabetes insipidus（P=0.027）and electrolyte disturbance（P=0.033）. The lamina terminalis approach is suitable for tumors resection with main part under the third ventricle and above optic chiasma,while the anterior interhemispheric fissure-corpus callosum-septum pellucidum-interforniceal approach is suitable for tumors resection with main part in the third ventricle. Conclusion：Selecting a appropriate operation approach and protecting the hypothalamus and the pituitary stalk according to the imaging characteristics of the tumor are the keys of the surgery.