瘤内切瘤技术在巨大颅内肿瘤切除中的应用

Intracapsular removal of giant intracranial tumors

目的探讨瘤内切瘤技术在巨大型颅内肿瘤切除中的应用价值。方法采用瘤内切瘤技术切除28例最大径≥6 cm的颅内巨大型肿瘤,技术要点包括:首先建立一有效的最小创伤的显露通道(入路);肿瘤起始显露应以适宜实施瘤内切除即可:对有明显瘤蒂的脑膜瘤应从蒂部开始,否则则从瘤中央开始,采取层层推进式切除;最后在牵引瘤壁下显微分离、切除瘤壁。结果共28例巨大肿瘤中19例获全切,8例获全切,1例获大部分切除。至最近随访(平均随访10.2个月),Kamofskv计分平均92.1分,较术前平均提高20分,无新的神经功能损伤,无脑脊液漏,无死亡。1例发生脑室内感染,经强力抗感染控制,1例发生瘤腔积血再手术清除,2例胶质瘤复发分别于术后4、11个月再次手术。结论在巨大型脑肿瘤切除中,充分实施瘤内切瘤技术,可实现肿瘤较好切除同时,显著减术中神经血管结构损伤,获得更佳疗效,该技术有较大推广应用价值。

Objective To explore the application and efficiency of intracapsular removal techniques in the operation of giant intracranial tumors. Methods 28 patients underwent an operation on giant intracranial tumors with largest diameter more than 6 cm by internal debulking techniques. Results Total resection was achieved in 19 cases, subtotal in 8, most in 1, without new brain functional damage, cerebrospinal fluid leak and mortality. The average Karnofsky performance scale score was 92.1 up to the recent follow-ups (average 10.2 months), 20 scores higher than the preoperative average. The complications included intracranial infection in one patient and surgical hematoma of tumor cavity in one patient. Two patients with glioma recurrence were re-operated on at the 4th and 11th month respectively. Conclusion Application of internal debuiking techniques in the removal of giant intracranial tumors can allow tumor removal to a great extent and reduce greatly operative damage to the brain, resulting in a better surgical prognosis. It is a valuable surgical technique for the removal of giant intracranial tumors.