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目的探讨幕下小脑上锁孔入路显微手术切除松果体区肿瘤的可行性和安全性。方法依据术前神经影像学检查结果,制定个体化手术方案．采用经幕下小脑上锁孔入路,显微手术切除病变7例。骨窗大小约2．0 cm×2．5 cm,上缘达横窦和窦汇下缘。结果7例中,胚生殖细胞瘤2例；松果体细胞瘤2例；松果体母细胞瘤1例；胶质瘤1例；胆脂瘤1例。术后均行MRI检查,肿瘤全切除6例,1例次全切除。并发术后小脑肿胀、脑积水1例,再次行手术减压；1例术后出现一过性缄默及凝视；无死亡、感染及术后出血病例。近期随访效果良好。结论应用幕下小脑上锁孔入路显微手术切除松果体区肿瘤不仅可取得满意的切除率,而且手术创伤小、疗效好。
Objective To investigate the feasibility and safety of supratentorial cerebellar keyhole approach microsurgical removal of pineal region tumors. Methods Based on the results of preoperative neuroimaging, we developed a personalized surgery program. Using the supratentorial cerebellar keyhole approach, microsurgery removed lesions in 7 cases. Bone window size of about 2.0 cm × 2.5 cm, the upper edge of the sinuses and the lower edge of sinus. Results Among 7 cases, 2 were embryo germ cell tumors, 2 were pineal cell tumors, 1 was pinealoblastoma, 1 was glioma and 1 was cholesteatoma. Postoperative MRI examination, total resection of the tumor in 6 cases, 1 case of subtotal resection. Concurrent postoperative cerebellar swelling, hydrocephalus in 1 case, again underwent surgical decompression; 1 case of postoperative transient silent and staring; no death, infection and postoperative bleeding cases. Recent follow-up effect is good. Conclusions The microsurgical removal of the pineal region tumor using the supratentorial cerebellar keyhole approach can not only achieve satisfactory resection rate, but also reduce the surgical trauma and improve the curative effect.