经胼胝体侧脑室脉络膜裂入路切除丘脑胶质瘤的临床效果观察

摘要

目的：探讨经胼胝体侧脑室脉络膜裂入路切除内侧型及外侧型丘脑胶质瘤的手术效果。方法：采用经胼胝体侧脑室脉络膜裂入路切除11例丘脑胶质瘤。在肿瘤一侧额叶开颅，经纵裂切开胼胝体体部，进入侧脑室，4例在脉络膜裂内侧纵形进入第三脑室，切除突出于第三脑室的丘脑肿瘤；7例在脉络膜裂的外侧切除丘脑肿瘤。结果：7例（63.6%）肿瘤次全切除，4例（36.4%）大部分切除。围手术期瘤腔出血1例。随访结果，1例术后4个月原位复发死亡，1例1年后复发再次手术，其他9例随访6~12个月逐渐恢复正常生活。结论：经胼胝体侧脑室脉络膜裂入路利用脑自然间隙到达并切除内外侧型丘脑胶质瘤，手术暴露好，丘脑毗邻结构损伤少，取得较为理想的手术效果。%Objective:To investigate the effect of resection of thalamic gliomas via transcallosal-ventricular-choroidal approach.Method:11 cases of thalamic gliomas were given surgical treatment via transcallosal-ventricular-choroidal approach.They were treated with frontal craniotomy in the tumor side and got into the lateral ventricle with longitudinal incision through the corpus callosum body.4 cases of thalamic tumors were removed through the medial choroidal fissure into the third ventricle,while the other 7 cases through the lateral choroidal fissure.Result:Subtotal resection was performed in 7 cases(63.6%)and partial resection in 4 cases(36.4%).Hematoma formed in the residual cavity of one of the tumors during perioperative period.l case died in four months because of local recurrence and 1 case needed reoperation in one year.The other 9 cases achieved satisfactory postoperative effects and lived in good neurological condition.Conclusion:Via transcallosal-ventricular-choroidal approach using brain natural gap to reach and remove the internal and external side of thalamic gliomas,good surgical exposure,less damage to adjacent structures of thalamus,the operation effect is very ideal.