经额底纵裂膜锁孔入路切除颅咽管瘤的手术方式及疗效分析

The surgical method and curative effect of resection of craniopharyngioma through sub-frontal longitudinal fissure duramater-keyhole approach

目的探讨经额底纵裂膜锁孔入路切除颅咽管瘤手术方法及疗效。方法回顾性分析首都医科大学三博脑科医院2017年1月至2021年1月采用经额底纵裂膜锁孔入路切除颅咽管瘤的179例患者的临床及影像学资料。结果通过该手术入路,肿瘤全切175例(97.77%),近全切2例(1.12%),部分切除2例(1.12%);术中磨除鞍结节31例(17.32%),切除已受肿瘤侵蚀的垂体柄166例(92.74%),保留正常垂体柄13例(7.26%);病理示乳头型颅咽管瘤27例(15.08%),造釉细胞型颅咽管瘤152例(84.92%);术后视力改善65例(36.31%),与术前相同53例(29.61%),视力下降6例(3.35%);术后电解质紊乱101例(56.42%),多饮多尿65例(36.31%),脑脊液鼻漏3例(1.68%),术后脑积水6例(3.35%)。术区出血2例(1.12%)。脑梗死6例(3.35%)。颅内感染8例(4.47%)。术后意识障碍4例(2.23%),死亡3例(1.68%)。结论经额底纵裂膜锁孔入路是微创原则与精细化原则的有效结合,对于治疗颅咽管瘤是安全有效的方法。

Objective To investigate the surgical method and curative effect of resection of craniopharyngioma through sub-frontal longitudinal fissure duramater-keyhole approach.Methods The clinical data,imaging data of 179 patients with craniopharyngioma treated by sub-frontal longitudinal fissure duramater-keyhole approach from January 2017 to January 2021 in Sanbo Brain Hospital Capital Medical University were studied retrospectively.Results Through this approach,total resection in 175 cases(97.77%),near total resection in 2 cases(1.12%),partial resection in 2 cases(1.12%);drilling of the tuberculum sellae in 31 cases(17.32%);the pituitary stalk was reserved in166 cases(92.74%),preserved in 13cases(7.26%);papillary craniopharyngioma in 27 cases(15.08%),ameloblastic craniopharyngioma in 152cases(84.92%);postoperative visual acuity improved in 65 cases(36.31%),not improved in 53 cases(29.61%),decreased in 6 cases(3.35%);electrolyte disorder in 101 cases(56.42%),polydipsia and polyuria in 65cases(36.31%),cerebrospinal fluid rhinorrhea in 3 cases(1.68%),hydrocephalus in 6 cases(3.35%).Postoperative hematoma in 2(1.12%)cases and cerebral infarction in 6 cases(3.35%),intracranial infection in 8 cases(4.47%),postoperative disturbance of consciousness in 4 cases(2.23%)and death in 3cases(1.68%).Conclusions Sub-frontallongitudinal fissure duramater-keyhole approach is an effective combination of minimally invasive and delicate surgery principle.It is a safe and effective method for the treatment of craniopharyngioma.