经楔前叶入路切除侧脑室三角区病变临床观察

Clinical observation of transprecuneus approach to resect the lesions located in the atrium of the lateral ventricle

目的分析经楔前叶入路切除侧脑室三角区病变的方法及预后。方法以2017-01—2022-01首都医科大学附属北京地坛医院神经外科采用顶枕开颅经楔前叶入路的20例侧脑室三角区病变患者为研究对象,其中19例病变全部切除(术后病理报告18例为脑膜瘤,1例为动静脉畸形),1例次全切除,术后病理报告脑梗死。结果1例患者术后出现短暂的部分性感觉性失语(失认),经治疗后逐渐好转;1例术后继发癫痫发作,口服丙戊酸钠缓释片抗癫痫治疗,控制良好;1例术后颅内感染,抗感染治疗后康复出院,其余患者均无肢体肌力下降、感觉减退、失语或偏盲等并发症,术后随访4~12个月,复查头颅增强磁共振未见肿瘤复发或快速生长,所有患者均回归正常生活、工作。结论经楔前叶入路切除侧脑室三角区病变具有微创、直接暴露肿瘤供血动脉、视野清晰等优点,手术治疗效果良好、安全性高。

Objective To analyze the method and prognosis of resection of lesions located in the atrium of the lateral ventricle via precuneus approach.Metheds From January 2017 to January 2022,20 cases of lateral ventricle trigonal lesions were treated by parieto-occipital craniotomy via precuneus approach in the Department of Neurosurgery,Beijing Ditan Hospital Affiliated to Capital Medical University.Among them,19 cases were com⁃pletely resected(18 cases were meningioma,1 case was arteriovenous malformation),1 case was subtotal resected,and the postoperative pathology reported cerebral infarction.Results One patient experienced transient partial sensory aphasia(agnosia)after surgery,which gradually improved after treatment;one patient suffered secondary seizures after surgery,which were well controlled by oral antiepileptic treatment with sodium valproate sustainedre⁃lease tablets;one patient suffered intracranial infection after surgery,recovered and was discharged from hospital after anti-infective therapy;the other patients had no complications such as decreased limb muscle strength,hypo⁃esthesia,aphasia or hemiblindness.The patients were followed up for 4-12 months after surgery.No tumor recur⁃rence or rapid growth was found in enhanced magnetic resonance examination.All patients returned to normal life and work.Conclusion Resection of lateral ventricle trigonal lesions via precuneus approach has the advantages of minimally invasive,direct exposure of tumor feeding artery,clear vision,and good surgical effect and high safety.