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目的:结合颅底手术入路提高鞍上、三脑室、脚间池大型颅咽管瘤的手术全切除率,提高疗效。方法:采用不同颅底手术入路显微手术切除37例鞍上、三脑室、脚间池大型颅咽管瘤。结果:肿瘤全切除35例,次全切除2例。术中解剖保留垂体柄31例,所有患者术后伴有不同程度一过性尿崩、动眼神经麻痹10例。全部病例平均随访3年,复发1例。结论:对位于鞍上、三脑室和脚间池的大型颅咽管瘤应根据肿瘤的不同生长方向采用相应的手术入路,充分暴露鞍区各脑池、视神经、前循环及其穿通支和三脑室底部等结构,对脑组织和脑神经牵拉小,术后并发症少且易控制,可取得较好的手术治疗效果。
Objective: To improve the curative effect by combining the operation of cranial skull base surgery to improve the surgical resection rate of large craniopharyngioma in suprasellar, third ventricle and foot pool. Methods: 37 cases of suprasellar, third ventricle and foot cavity large craniopharyngioma were excised by microsurgical operation of different skull base operation. Results: Tumor resection in 35 cases, subtotal resection in 2 cases. Intraoperative anatomical retention of pituitary stalk in 31 cases, all patients with varying degrees of postoperative transient diabetes insipidus, oculomotor nerve paralysis in 10 cases. All patients were followed up for an average of 3 years, 1 case of recurrence. Conclusion: The large craniopharyngioma located in the suprasellar, the third ventricle and the interocentesis should adopt appropriate surgical approach according to the different growth directions of the tumor, which fully exposed each cerebral cistern, optic nerve, anterior circulation and its perforation and Third ventricle at the bottom of the structure of the brain tissue and cranial nerve traction small, less postoperative complications and easy to control, can achieve better surgical treatment.