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目的探讨神经内镜手术治疗脑室内肿瘤合并脑积水的方法与技巧。方法回顾性分析10例脑室内肿瘤合并脑积水的临床资料,其中肿瘤位于侧脑室5例,第三脑室4例,脑室内多发肿瘤1例。均在神经导航指引下行内镜手术,同时行第三脑室造瘘术9例,透明隔造瘘术1例。结果肿瘤全切除8例,次全切除1例,仅行活检1例。术后颅高压症状均缓解,发现不同程度发热3例,无癫间疒发作及其他严重并发症。术后脑脊液磁共振电影成像(Cine MRI)显示所有病人脑脊液循环动力学均不同程度改善。随访3～24个月,平均10.6个月,死亡1例,无肿瘤复发;复查MRI显示脑室体积轻度缩小2例,无明显变化8例。结论神经内镜手术既可切除肿瘤,又能重建脑脊液循环,可作为脑室内肿瘤合并脑积水的首选治疗方法。应根据脑室形态和肿瘤位置、大小、性质等在导航引导下选择个体化的手术入路切除肿瘤。
Objective To investigate the methods and techniques of neuroendoscopic surgery for the treatment of intracranial tumors combined with hydrocephalus. Methods Retrospective analysis of 10 cases of intraventricular tumor with hydrocephalus clinical data, including tumor in the lateral ventricle in 5 cases, the third ventricle in 4 cases, 1 case of intraventricular multiple tumors. Nerve navigation guidelines were guided endoscopic surgery, while the third ventricle ostomy in 9 cases, 1 case of translucent fistula. Results Tumor resection in 8 cases, subtotal resection in 1 case, only biopsy in 1 case. Postoperative symptoms of intracranial hypertension were relieved and found 3 cases of varying degrees of fever, no epileptic seizures and other serious complications. Postoperative cerebrospinal fluid magnetic resonance imaging (Cine MRI) showed that all patients had improved cerebrospinal fluid circulation kinetics to varying degrees. All the patients were followed up for 3-24 months with an average of 10.6 months and 1 patient died without tumor recurrence. MRI showed that the ventricular volume was slightly reduced in 2 cases and no obvious change in 8 cases. Conclusion Neuro-endoscopic surgery can both excise the tumor and reconstruct the cerebrospinal fluid circulation. It can be used as the first choice for the treatment of intraventricular combined with hydrocephalus. Should be based on ventricular morphology and tumor location, size, nature, etc. in the guidance of navigation under the choice of individualized surgical approach to remove the tumor.