论文部分内容阅读
目的探讨颅咽管瘤的微侵袭治疗方法的选择及并发症。方法 :4 6例颅咽管瘤患者 ,30例行显微手术切除 ,其中 2 5例行全切除 ,5例行大部分切除后予γ刀治疗 ,6例行单纯γ刀治疗 ,10行MRI立体定向囊内放射治疗。结果 :手术组 2 5例全切除患者 ,术后 2 1例恢复正常工作 ,2例需生活照顾。随访 2年以上 16例 ,CT或MRI检查未见肿瘤复发 ,2例死亡 ,其中 2例死于下丘脑损害。γ刀治疗组 11例患者临床症状明显改善 ,随访 6～ 30个月 ,MRI检查显示 4例肿瘤完全消失 ,5例缩小 ,2例无变化 ,无术后并发症。囊腔放疗组 10例经手术排除囊液后临床症状明显改善 ,随访 3～ 30个月 ,MRI显示 3例肿瘤完全消失 ,7例瘤腔明显缩小 ,无手术死亡率及严重并发症。结论 :显微手术全切除颅咽管瘤仍是目前理想的治疗方法 ,γ刀治疗适用于实质性和部分实质性 ,体积较小 (<3～ 4cm)的肿瘤。对囊性体积较大的颅咽管瘤行立体定向囊腔内放疗是一种十分安全有效的方法。
Objective To explore the selection and complications of minimally invasive treatment for craniopharyngioma. Methods: Forty-six patients with craniopharyngioma underwent microsurgical resection. Twenty-five patients underwent total resection, five patients underwent gamma knife treatment after the majority of resection, six patients underwent gamma knife treatment and ten MRIs Stereotactic intracapsular radiation therapy. Results: In the operation group, 25 cases of total resection patients, 21 cases of postoperative recovery to normal work, 2 cases need life care. Followed up for more than 2 years in 16 cases, CT or MRI examination showed no tumor recurrence, 2 died, 2 of them died of hypothalamic injury. Gamma knife treatment group 11 patients with clinical symptoms improved significantly, 6 to 30 months follow-up, MRI examination showed 4 cases of tumor disappeared completely, 5 cases reduced, 2 cases no change, no postoperative complications. The clinical symptoms in 10 patients with cystic cavity radiotherapy were significantly improved after operation. After 3 to 30 months of follow-up, MRI showed complete disappearance of the 3 tumors, 7 cases of tumor cavity shrinking obviously, no operative mortality and serious complications. CONCLUSION: Microsurgical resection of craniopharyngioma is still the ideal method of treatment. Gamma knife treatment is suitable for the treatment of solid tumors and small tumors (<3 ~ 4cm in size). Stereotactic intracavitary radiotherapy for cystic craniopharyngioma is a very safe and effective method.