手术治疗第三脑室肿瘤的临床分析

Clinical Analysis of Surgical Resection of Third Intraventricular Tumors

目的探讨第三脑室肿瘤的手术治疗方法和临床特点。方法回顾性分析行手术治疗的42例第三脑室肿瘤的临床资料。结果本组表现为颅高压症状25例,记忆力减退18例,视觉障碍17例,Parinaud征9例,肾上腺皮质功能不全、肢体偏瘫、尿崩症、缄默各6例,癫痫4例,甲状腺功能低下3例,间脑癫痫2例。手术经额皮层入路13例,经终板入路4例,经纵裂-胼胝体入路23例,经后方入路2例。肿瘤全切除35例,次全切除7例,均无术中死亡,手术时间1～6. 5 h,出血量50～2500 ml。术后发生脑室血肿4例,中枢神经系统感染7例,继发性脑积水5例,肾上腺皮质功能不全、缄默各8例,尿崩症6例,甲状腺功能低下2例,均予对症处理。本组经组织病理检查确诊为生殖细胞肿瘤16例,三脑室内型颅咽管瘤、脑膜瘤各4例,星形细胞瘤、胶样囊肿及脊索样胶质瘤各3例,室管膜瘤、胶质母细胞瘤及脉络丛乳头状瘤各2例,中枢神经细胞瘤、间变星形细胞瘤及少枝胶质瘤各1例。随访3个月～3年,病情复发、死亡各4例。结论第三脑室肿瘤临床少见,应根据肿瘤位置、大小、生长方式等制定合理的手术方式。

Objective To explore surgical treatment method and clinical features of third ventricle tumor in third ventricles.Methods Clinical data of42cases of third ventricle tumor undergoing surgery were analyzed retrospectively.Results The preoperative symptoms of high intracranial pressure were presented in25cases,memory impairment in18cases,visual impairment in17cases,Parinaud syndrome in9cases,adrenocortical insufficiency,limb hemiplegia,diabetes insipidus and mutism in6cases respectively.epilepsy in4cases,hypothyroidism in3cases,and diencephalon epilepsy in2cases.Intraoperatively,13cases were treated by transfrontal transcallosal approach,23cases by transcallosal approach,4cases by trans-lamina terminalis approach,and2cases by posterior approach.Total removal was achieved in35cases,and subtotal removal in7cases.There were no intraoperative deaths.The duration of operation ranged from1to6.5h and the bleeding volume ranged from50to2500ml.Postoperative complications included ventricle hematoma in4cases,central nervous system infection in7cases,secondary hydrocephalus in5cases,adrenal insufficiency in8cases and mutism in8cases,diabetes insipidus in6cases and hypothyroidism in2cases.Therefore,they were given symptomatic treatment.Histopathological results showed16cases of germ cell tumors,4craniopharyngioma,4meningioma,3astrocytoma,3colloid cyst and3chordoid glioma,2ependymoma,2glioblastoma and2choroid plexus papilloma,1central neurocytoma,1anaplastic astrocytoma and1oligodendroglioma respectively.After follow-up for3months to3years,relapse and death were reported in4cases respectively.Conclusion Becasue the third intraventricular tumor is rare,a reasonable surgical approach should be selected according to the location,size and growth pattern of the tumor preoperatively.