侧脑室肿瘤的显微手术治疗策略

Microsurgical treatment strategy for lateral ventricle tumor

目的探讨侧脑室肿瘤不同显微手术入路的应用及手术治疗策略。方法回顾性分析武汉协和医院神经外科于2006年3月~2013年4月行显微手术治疗的42例患者的临床资料,包括手术入路、结果及预后情况等。42例患者年龄1.25~67岁,平均35.8岁。所有患者均行显微手术治疗,其中7例经额中回、2例经纵裂-胼胝体前、18例经顶上小叶、15例经颞叶皮质入路手术。结果本组28例（66.7%）全切除,11例（26.2%）次全切除,3例（7.1%）大部分切除。术后死亡2例（4.8%）。随访38例患者,随访时间39~97月,平均70月。格拉斯哥预后评分（GOS）1分8例,3分2例,4分3例,5分25例。结论侧脑室肿瘤位置深在,局部解剖关系复杂,需综合考虑肿瘤位置、大小、生长方向等因素以确定手术入路。采用合适的手术入路及熟练的显微手术技巧,可以使大部分侧脑室肿瘤患者获得较好的疗效。

Objective To investigate the application of various microsurgical approaches and microsurgical treatment strategy for lateral ventricle tumor. Methods A retrospective analysis was performed for the clinical data of 42 patients with lateral ventricle tumor who underwent microsurgical treatment in Wuhan Union Hospital from March 2006 to April 2013,including surgical approach,outcome,and prognosis. The patients＇ mean age was 35. 8 years（ range 1. 25- 67 years）. All the patients underwent the microsurgical treatment,of whom 7 used middle frontal gyrus approach,2 used longitudinal fissure-anterior transcallosal approach,18 used superior parietal lobule approach,and 15 used temporal lobe cortex approach. Results Of all patients,28（ 66. 7%） underwent total resection,11（ 26. 2%） underwent subtotal resection,and 3（ 7. 1%） underwent partial resection. Two patients（ 4. 8%） died after surgery. A total of 38 patients were followed up for a mean time of 70 months（ range 39- 97 months）. As for the Glasgow Outcome Scale score,8 patients had 1 point,2 had 3 points,3 had 4 points,and 25 had 5 points. Conclusions Lateral ventricle tumor has a deep location and a complex local anatomical relationship,and the determination of surgical approaches should consider the factors such as tumor location,size,and growth direction. Appropriate surgical approaches and proficient microsurgical skills help patients with lateral ventricle tumor to achieve a good outcome.