神经内镜在囊性颅咽管瘤治疗中的作用

Role of Neuroendoscopy in Treatment of 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15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,之后再辅以放射治疗或显微手术切除。结果 15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。内镜治疗后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,是进一步提高治疗效果、降低致残率和死亡率的有效方法。

Objective To investigate the role of neuroendoscope in treatment of the large cystic craniopharyngiomas. Methods Neuroendoscope was firstly applied to shrinking the volume of the tumors, obliterating obstructive hydrocephalus, and canalizing the intervals of the cysts in 15 patients with large cystic craniopharyngiomas accompanied with obstructive hydrocephalus. Then, the tumors were treated further by radiotherapy or microsurgical resection. Results The symptoms of the intracranial hypertension disappeared and the other symptoms improved postoperatively in all 15 patients. Imagings (CT or MR) showed that the tumors shrinked to the sellar region and hydrocephalus disappeared. There were not exist severe complications in the patients except 1 patient with transitory polyuria and hyponalremia. Postoperative responses were obviously abated in 3 cases with cystic craniopharyngiomas resected totally after the endoscope operation. Conclusion Neuroendoscopic technique is an effective way to improve curative effect and dicrease disable rate and mortality in the patients with large cystic craniopharyngiomas accompanied with hydrocephalus.