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目的 探讨颅咽管瘤显微手术切除的方法和入路。方法 45例经显微手术切除的颅咽管瘤中,囊性者34例(有钙化者26例),实质性11例;肿瘤直径2cm或以下者5例,2.1～4.0cm29例,4.1～6.0cm 6例,>6.0cm者5例。4例三脑室内肿瘤经胼胝体前入路,经胼胝体-翼点联合入路2例,39例经右翼点入路切除肿瘤。结果 经术中观察和影像学资料证实,全切除41例,次全切除2例,大部切除2例,随访2月～4年,参加工作或学习者38例,需生活照顾者5例,死亡2例,均系实质性肿瘤。结论早期诊断的颅咽管瘤显微手术全切除,效果理想;巨大、实质性肿瘤且伴有糖尿病者手术危险性很大。翼点入路是鞍区颅咽管瘤显微手术切除的最佳入路。
Objective To investigate the microsurgical removal of craniopharyngioma and its approach. METHODS: Forty-five cases of craniopharyngioma resected microsurgically underwent microsurgical resection. There were 34 cases of cystic degeneration (26 cases with calcification) and 11 cases of pituitary tumor. There were 5 cases with tumor size of 2 cm or less, 29 cases with 2.1-4.0 cm, 6.0cm 6 cases,> 6.0cm in 5 cases. Four cases of three-ventricle tumors through the corpus callosum, via the corpus callosum-wing point approach in 2 cases, 39 cases by right-wing point approach to remove the tumor. Results According to the intraoperative findings and imaging data, 41 cases were completely resected, 2 cases were subtotally resected, 2 cases were mostly resected. The patients were followed up for 2 months to 4 years. 38 patients participated in the work or study, Two patients died, all of which were substantial tumors. Conclusion The early diagnosis of craniopharyngioma by microsurgical total resection, the effect is ideal; huge, substantial tumor and associated with diabetes are very dangerous. Winged point approach is the best approach for microsurgical resection of craniopharyngioma in the sellar region.