56例儿童颅咽管瘤的显微手术治疗及随访

摘要

目的:探讨儿童颅咽管瘤显微手术方法,术后并发症的防治及复发的因素.方法:回顾性分析我院2000年1月至2010年12月儿童颅咽管瘤手术病例56例.分别采用经翼点入路28例(50%)、经额下入路14例(25%)、经前额纵裂入路6例(10.7%),经胼胝体-透明隔间腔-穹隆间入路5例(8.9%),皮层造瘘入路3例(5.3%).结果:全切除+次全切除38例(67.9%)、大部切除17例(30.4%),围手术期死亡1例(1.7%).术后并发症主要为尿崩症、血电解质紊乱及癫痫.结论:恰当地选择手术入路、术中娴熟的显微神经外科操作、术后积极防治并发症,是影响颅咽管瘤复发及预后的关键因素.%Objective: To explore the microsurgical methods for treating craniopharyngiomas, the prevention of complications and the factors influencing recurrence. Methods: From January 2000 to December 2010,56 cases of pediatric craniopharyngioma undertook microsurgery. Five different approaches were used, including the pterional approach in 28 cases( 50％ ) , the subfrontal approach in 14 cases( 25％ ) , the transfrontal longitudinal fission approach in 6 cases ( 10. 7％ ),the transcallosum interfornix approach in 5 cases ( 8. 9％ ) , and transcortical approach in 3 cases ( 5. 3％ ). Results : Total or subtotal resection was performed in 38 cases ( 67. 9％ ) , and partial removal was performed in 17 cases ( 30. 4％ ). Perioperative death in 1 case ( 1. 7％ ). Major postoperative complications were diabetes insipidus,blood electrolyte disorder and epilepsy. Conclusion: The proper choice of operative approach, skillful intraoperative microsurgical performance and the active postoperative prevention of complications are key factors influencing the recurrence and prognosis of craniopharyngioma.