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有关颅咽管瘤的手术一直是神经外科医师最感困惑的问题。本文报道经蝶显微手术切除颅咽管瘤18例,均经CT或MRI扫描确诊。本入路适用起源于鞍底或向鞍上扩展的肿物。手术采取经唇下-鼻中隔-蝶窦入路或经鼻前庭-鼻中隔-蝶窦入路两种方式行肿瘤切除术。9例肿瘤获得全切除,4例次全切除,其余5例为部分切除,术后无死亡。15例获长期(平均3.1年)随访,有12例(80.0％)恢复良好,3例影像学检查提示肿瘤复发,需行再次手术,放疗或放射外科治疗。文中对颅咽管瘤手术适应证选择及操作要点进行了讨论。
Surgery on craniopharyngiomas has always been the most troubling issue for neurosurgeons. This article reports the removal of craniopharyngioma by transsphenoidal microsurgery in 18 cases were confirmed by CT or MRI scan. This approach applies to originate in the saddle or saddle to expand the tumor. Surgical resection through the lip - nasal septum - sphenoid sinus approach or nasal vestibule - nasal septum - sphenoid sinus approach two ways of tumor resection. Nine patients underwent total resection, four underwent total excision, and the remaining five underwent partial resection without any postoperative death. Fifteen patients were followed up for a long time (average 3.1 years). 12 cases (80.0%) recovered well. Three cases of tumor recurrence were confirmed by radiological examination. Reoperation, radiotherapy and radiosurgery were required. This article discusses the choice of craniopharyngioma surgery indications and operating points are discussed.