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目的 探讨第三脑室前部颅咽管瘤的手术入路及术后并发症的防治。方法 经终板 翼点入路切除 7例第三脑室前部颅咽管瘤 ,其中囊性肿瘤 2例 ,实体肿瘤 5例。结果 本组全切除 2例 ,次全切除 4例 ,大部切除 1例。 7例术后均发生水电解质紊乱 ,对症采用口服白开水和使用速尿或口服食盐的方法有效。 2例实体肿瘤死于呼吸衰竭。存活 5例随访 2～ 9年 ,1例次全切除者术后半年死于肺炎 ,另次全切除和全切除者各 2例经CT/MR复查 ,除 1例次全切除者术后 8年 1个月肿瘤复发外 ,其余 3例未见复发。结论 经终板 翼点入路较单纯经终板或翼点入路方便、安全。呼吸衰竭是最严重的并发症 ,术后维持水电解质平衡是治疗的关键。术后常规放疗可以减少肿瘤复发。
Objective To investigate the surgical approach of craniopharyngioma in front of the third ventricle and the prevention and treatment of postoperative complications. Methods Seven cases of craniopharyngioma in the front of the third ventricle were excised via the pterional approach. There were 2 cystic tumors and 5 solid tumors. Results The group of total resection in 2 cases, subtotal resection in 4 cases, mostly in 1 case. Electrolyte disorder occurred in 7 cases after operation, and symptomatic treatment was effective with oral boiled water and furosemide or oral salt. Two solid tumors died of respiratory failure. Survival in 5 cases was followed up for 2 to 9 years. One sub-total resection died of pneumonia six months after operation. Two cases underwent total resection and total resection by CT / MR respectively. Except for 1 sub-total resection after 8 years One month tumor recurrence, the remaining three cases no recurrence. Conclusions The end-plate pterional approach is more convenient and safe than the end-plate or pterional approach alone. Respiratory failure is the most serious complication, and maintaining the water-electrolyte balance after surgery is the key to treatment. Conventional radiotherapy can reduce tumor recurrence.