神经内镜在丘脑胶质瘤手术中的应用

Application of neuroendoscope in thalamic gliomas operation

目的 探讨神经内镜在丘脑肿瘤手术中的应用.方法 回顾性分析2009年12月至2013年12月首都医科大学附属北京世纪坛医院神经外科收治的10例丘脑胶质瘤患者.其中内侧型丘脑胶质瘤5例,前侧型丘脑胶质瘤3例,腹后侧型丘脑胶质瘤2例.手术在神经导航引导下应用神经内镜进行,术后常规随访,并进行远期生活质量评估（KPS）.结果 内镜下切除肿瘤至胶质增生带6例,大部分切除肿瘤3例,肿瘤活检1例.术后有2例患者出现神经功能障碍,表现为不同程度的肢体和语言障碍,但在3个月内恢复或改善.2例术前偏瘫的患者在术后短期内症状得到明显改善,KPS评分从术前的60 ～ 70分增加到术后的80 ～ 90分.1例患者因为瘤腔积液,行二次手术治疗.术后6例患者进行放、化疗,1例未行其他治疗,3例患者定期随访观察.所有患者随访3个月至1年,1例复发死亡,余KPS评分无明显降低.结论 神经导航引导下应用神经内镜对部分丘脑胶质瘤患者可进行有效切除,可降低患者术后神经功能障碍的发生率.

Objective To explore the neuroendoscopic application in the surgical treatment of thalamic gliomas.Methods A total of 10 patients with thalamic glioma between December 2009 to December 2013 in Beijing Shijitan Hospital,Capital Medical University were retrospectively analyzed.The l0 cases include 5 cases of medial type,3 cases of anterior type and 2 cases of abdominal rear type.The operations were performed by using neuroendoscope under the neuronavigation guidance.All the cases were followed up and measured by the Karnofsky performance scale （KPS）.Results Six cases were totally removed,3 cases were subtotally removed and 1 case underwent biopsy.2 cases suffered hemiparesis and speech difficulty after operation but recovered within 3 months.2 cases with hemiplegia improved significantly,KPS score increased from 60-70 before operation to 80-90 after operation.1 case was performed reoperation because of tumor cavity effusion.6 cases received postoperative radio-chemotherapy,1 case was treated without any other therapy,3 cases were regularly followed up.All cases were followed up from 3 months to 1 year,1 case died of recurrence,KPS score of other patients increased after operation.Conclusion A portion of thalamic gliomas could be effectively removed by using neuroendoscope under the neuronavigation guidance and the incidence of postoperative neurological dysfunction could be reduced.