神经内镜辅助下松果体区表皮样囊肿的手术治疗

摘要

目的 探讨神经内镜辅助下松果体区表皮样囊肿的手术效果及脑功能保护.方法 采用枕下幕上入路,在显微镜下切除大部分肿瘤,再辅助神经内镜切除残余肿瘤,配合软镜观察第三脑室及中脑导水管等结构,清除脑室内凝血块及漂浮物.结果 4例肿瘤成功全切,被肿瘤侵蚀或包绕的血管、神经及脑干等结构保护良好；1例因肿瘤包膜与大脑内静脉粘连,残余部分电灼后未全切.术中出血量180 ～400 ml,平均316 ml;手术时间138 ～330 min,平均253.6 min.术后无菌性脑膜炎1例(复发性胆脂瘤),抗生素及腰穿置管后治愈；1例术后2周发生迟发性脑积水,行第三脑室底造瘘术后症状改善；术后无迟发性脑出血.5例随访3 ～12个月,平均5.8月,无复发肿瘤.结论 神经内镜辅助下松果体区胆脂瘤切除术,可以多角度环视病变,指导肿瘤切除.%Objective To explore the effects of neuroendoscopic-assisted surgery for pineal epidermoid cyst and protection of the brain function.Methods By suboccipital and supratentorial approach,most tumors were removed under microscope,and the residual tumors were desected under neuroendoscopy.Soft neuroendoscopy was used to observe the structure of the third ventricle and midbrain aqueduct,and the sludged blood and floating debris in the ventricular system were washed away to reduce the incidence of postoperative hydrocephalus.Results The tumors were totally removed in 4 cases under neuroendoscopy and the involved vessels,nerves and brainstem were intact.A tumor of 1 patient was not totally removed after being fulgerized due to the adhesion of tumor capsule with Galen vein.The blood loss ranged from 180 to 400 ml(mean,316 ml),and the operation time was 138-330 min,with an average of 253.6 min.One patient suffered from aseptic meningitis,who recovered after antibiotics administration and lumbar puncture cathetering.Late-onset hydrocephalus occurred in one case 2 weeks after operation,and the symptoms were improved following the third ventriculostomy.Five patients were followed up for 3-12 months(mena,5.8 months),and none of them relapsed.Conclusion Neuroendoscopic-assisted surgery for pineal epidermoid cyst can observe the diseased area from different angles,and be used to guide tumor resection.