采用直切口和无持续牵拉技术经纵裂-胼胝体-穹隆间入路切除第三脑室肿瘤

摘要

目的 探讨直切口和无持续牵拉技术在经纵裂-胼胝体-穹隆间入路切除第三脑室肿瘤中的可行性、优点及意义.方法 回顾性分析31例第三脑室肿瘤病人的临床资料,采取经纵裂-胼胝体-穹隆间入路手术切除.右额旁正中线直切口6～7 cm,直径4cm大小的骨窗,分离纵裂、胼胝体及穹隆柱进入第三脑室,术中不使用固定牵开器,不持续使用脑压板牵拉暴露.术后评价肿瘤切除程度、神经功能损伤及并发症等情况.结果 术后MRI证实肿瘤全切除25例,全切除率80.6％,部分切除6例.术后病理类型:颅咽管瘤7例,胶质母细胞瘤6例,生殖细胞瘤5例,间变性星形细胞瘤3例,弥漫性星形细胞瘤3例,少突胶质细胞瘤3例,转移瘤2例,胶样囊肿2例.术后出现神经功能损伤4例,脑室内出血2例,癫癎3例以及脑积水2例.随访6个月～2年,无硬膜下积液和皮下积液发生.结论 采用直切口和无持续牵拉技术经纵裂-胼胝体-穹隆间入路手术,可充分暴露及切除肿瘤,并减少因术中牵拉导致的神经功能损伤以及皮下积液等并发症.%Objective To investigate the feasibility,advantages and significance of straight incision and no continuous traction in the resection of third ventricle tumor via interhemispheric-transcallosal-interforniceal (ITI) approach.Methods Clinical data of 31 patients with tumors in the third ventricle were analyzed retrospectively,who underwent resection via 1TI approach.All the patients were operated by a straight incision of 6 to 7 cm which was near to the middle line of the right forehead and a bone window with diameter of 4 cm.Then,the fissure,corpus callosum and fornical column were separated to enter the third ventricle.The self-retaining retractor and constant brain spatula pulling were not allowed during the surgery.The extent of tumor resection,postoperative neurological deficit and complications were analyzed after surgery.Results Postoperative MRI showed that total resection was achieved in 25 patients (80.6％) and partial resection in 6.The pathological examination results as follows:craniopharyngioma in 7,glioblastoma in 6,germ cell tumor in 5,anaplastic astrocytoma in 3,diffuse astrocytoma in 3,oligodendroglioma in 3,metastatic tumor in 2 and colloid cyst in 2.The postoperative complications included neurological deficits in 4,intraventricular hemorrhage in 2,epilepsy in 3 and hydrocephalus in 2.All the patients were followed up for 6 months to 2 years,there was no occurrence of subdural effusion and subcutaneous effusion.Conclusion The application of straight incision and no continuous traction in the resection of third ventricle tumor via 1TI approach can expose and remove the tumor completely and decrease the neurological deficits induced by traction during the surgery and subcutaneous effusion.