幕下小脑上入路显微切除松果体区肿瘤

Microsurgical resection of tumors in pineal region through infratentorial supracerebellar approach

目的 探讨经幕下小脑上入路(Krause入路)显微外科切除松果体区肿瘤的方法和治疗效果。方法 分析1998年3月至2002年4月收治的松果体区肿瘤8例,其中生殖细胞瘤4例,胶质瘤2例,松果体瘤和松果体囊肿各1例。所有病人均采用坐位、气管内插管全麻、经Krause入路显微肿瘤切除,其中2例术中辅助影像导航定位。结果 除1例胶质瘤与大脑大静脉粘连,残存少许肿瘤外,其余病例均达解剖切除,脑脊液循环通畅,无后遗症状。结论 坐位Krause入路显示三脑室后部病变解剖结构清晰,病变暴露良好,基本能达到病灶全切。

Objective To explore the technique and curative effect of microsurgery on the tumors in the pineal region through the infratentoria supracerebellar approach. Methods Of 8 patients with pineal region tumors treated in our hospital from March, 1998 to April, 2002, 4 suffered from germinomas, 2 glioma, 1 pinealoma and 1 pineal cyst. The tumors were microsurgically resected trough the infratentorial supracerebellar approach in all patients, who were kept sitting and underwent endotracheal intuhation anesthesia during the operation. The neuronavigation assisted operation were performed in 2 patients. Results The lesions were totally respected in 7 patients, partly in 1 patient because of glioma adhesion to great cerebral vein. The hydrocephaluses as relieved, symptom were improved and there were no complications after the operation in all the patients. Conclusions The pineal region tumors located in the rear of the third ventricle were exposured very well and basically are totally resected through the infratentorial supracerebellar approach.