第三脑室肿瘤的锁孔微创手术治疗

发布时间：2018-07-31 16:11

【摘要】：目的：探讨锁孔微创手术治疗第三脑室肿瘤的个体化入路设计及临床疗效方法：对苏州大学附属第二医院从2000年8月至2013年8月收治的64例第三脑室肿瘤患者，根据病灶特点及生长方式，分别设计经眉弓眶上额下锁孔入路、天幕下小脑上锁孔入路、纵裂胼胝体锁孔入路、翼点锁孔入路及枕部锁孔入路，从前方、后方、上方或侧方进入第三脑室切除肿瘤。术中切除肿瘤后打通脑脊液循环通路，确保第三脑室脑脊液循环通畅。结果：肿瘤全切51例（79.69%），，次全切13例（20.31%）；无手术死亡病例，无因术中病情变化或暴露不良而扩大切口及骨瓣的病例；前方锁孔入路尿崩及视力视野恶化的发生率均为8.70%（4/46）、幕下小脑上锁孔入路小脑肿胀的发生率为7.69%（1/13），所有锁孔入路术后出血、颅内感染、意识障碍、脑脊液切口漏的发生率分别为：3.13%、3.13%、1.56%、1.56%；无癫痫以及牵拉脑组织导致的脑挫伤等并发症；术前37例有脑积水者36例术后均好转或消失，仅1例术后2月因交通性脑积水行腰大池-腹腔脑脊液分流术。结论： 1、锁孔微创手术是治疗第三脑室肿瘤的有效办法，能安全、微创地切除肿瘤，并一期解除脑脊液循环通路的梗阻。 2、设计个体化的锁孔入路是第三脑室肿瘤手术成功的保障：纵裂胼胝体锁孔入路适合于第三脑室中上部肿瘤手术；天幕下小脑上锁孔入路适合于第三脑室后部肿瘤手术；枕部锁孔入路适合于第三脑室侧方生长的肿瘤手术；经眉弓眶上额下锁孔入路、翼点锁孔入路适合于第三脑室前部肿瘤手术，而经眉弓眶上额下锁孔入路可更纵深方向显露第三脑室。
[Abstract]:Objective: to investigate the design and clinical efficacy of keyhole minimally invasive approach for the treatment of third ventricular tumors. Methods: 64 patients with third ventricle tumors were treated in the second affiliated Hospital of Suzhou University from August 2000 to August 2013. According to the characteristics of the lesions and the growth pattern, the transorbital subfrontal keyhole approach, the supracerebellar keyhole approach, the corpus callosum keyhole approach, the pterional keyhole approach and the occipital keyhole approach were designed respectively. The tumor is removed by entering the third ventricle on the top or side. The cerebrospinal fluid (CSF) circulation pathway was opened after tumor resection to ensure the smooth circulation of cerebrospinal fluid (CSF) in the third ventricle. Results: there were 51 cases (79.69%) with total tumor resection and 13 cases (20.31%) with subtotal resection. The incidence of anterior keyhole approach and visual field deterioration were 8.70% (4 / 46), 7.69% (1 / 13) and 7.69% (1 / 13), respectively. The incidence of cerebrospinal fluid incision leakage was 1.56% and 1.56%, respectively; there were no complications such as epilepsy and brain contusion caused by pulling brain tissue, and 36 cases with hydrocephalus were improved or disappeared after operation. Only 1 case underwent lumbar cistern-celiac cerebrospinal fluid shunt 2 months after operation because of communicating hydrocephalus. Conclusion: 1. Keyhole minimally invasive surgery is an effective method for the treatment of tumors of the third ventricle, which can be safely and minimally invasive. At one stage, the obstruction of cerebrospinal fluid circulation pathway was relieved. 2. The design of individualized keyhole approach was the guarantee for the successful operation of the third ventricle tumor: the keyhole approach of the corpus callosum was suitable for the operation of the tumors in the middle and upper part of the third ventricle; The supratentorial keyhole approach is suitable for the surgery of posterior third ventricle neoplasms; the occipital keyhole approach is suitable for tumor surgery on the lateral side of the third ventricle; The pterygoid keyhole approach is suitable for the operation of anterior third ventricle tumor, and the supraorbital subfrontal keyhole approach can expose the third ventricle in the deeper direction.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R739.41

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