经枕部后纵裂-天幕入路切除松果体区及三脑室后部肿瘤
Resection of tumors in pineal region and posterior third ventricle via occipital interhemispheric transtentorial approach
王雷 1刘仁忠 1熊晓星 1王峻 1连海伟 1余信远 1邵灵敏 1简志宏1
作者信息
- 1. 武汉大学人民医院神经外科 湖北 武汉 430060
- 折叠
摘要
目的:探讨经枕部后纵裂-天幕入路切除松果体区及三脑室后部肿瘤的经验和疗效.方法:回顾性分析2019年5月至2022年1月收治的12例松果体区及三脑室后部肿瘤患者的临床资料,观察其临床疗效.结果:病理结果示生殖细胞肿瘤3例(其中单纯生殖细胞瘤2例),星形细胞瘤2例,胶质母细胞瘤1例,松果体细胞瘤2例,表皮样囊肿3例,小细胞神经内分泌癌(肺来源)1例.肿瘤全切10例(83.3%),次全切2例(16.7%).无死亡病例.所有病例中,5例患者在切除肿瘤前行脑室外引流术,切除肿瘤后行三脑室底造瘘或终板造瘘缓解脑积水(其中2例在内镜下行造瘘术).术后1例患者脑室外引流管拔除不能,行脑室-腹腔分流术(VPS)治疗后好转.结论:经枕部后纵裂-天幕入路能够有效切除松果体区及三脑室后部肿瘤,切除肿瘤后可行三脑室底造瘘或终板造瘘缓解脑积水,值得推广.
Abstract
Objective:To investigate the clinical effect of resection of pineal region and posterior third ventri-cle tumors via occipital interhemispheric transtentorial approach.Methods:The clinical data of 12 pa-tients with the pineal region and posterior third ventricle tumors from May 2019 to January 2022 were re-trospectively studied,and the clinical curative effect was observed.Results:Pathological results showed that there were 3 cases of germ cell tumor(including 2 cases of single germinomas),2 cases of astrocytoma,1 case of glioblastoma,2 cases of pineocytomas,3 cases of epidermoid cysts,and 1 case of small cell neuroendocrine carcinoma(lung origin).Total tumor resection was performed in 10 cases(83.3%)and subtotal resection in 2 cases(16.7%).All cases were survived after operation.Among the 12 cases,5 cases underwent extraventricular drainage by drilling before tumor resection,and after tumor resection,they underwent a third ventriculostomy or endplate ostomy to relieve hydro-cephalus(2 of them underwent endoscopic ostomy).One patient still had hydrocephalus after the oper-ation,which was treated by a ventriculoperitoneal shunt(VPS).Conclusion:The occipital interhemi-spheric transtentorial approach can effectively remove the tumors in the pineal region and posterior part of the third ventricle.After the tumors are removed,the third ventriculostomy or endplate osto-my can be used to relieve hydrocephalus,which is worthy of promotion.
关键词
松果体区肿瘤/三脑室后部肿瘤/手术入路/显微手术Key words
Pineal Region Tumors/Posterior Third Ventricle Tumors/Surgical Approach/Microsurgery引用本文复制引用
基金项目
湖北省卫生健康委员会科研项目(WJ2021M148)
出版年
2024
NETL
NSTL
万方数据