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目的探讨不同手术入路切除颞叶内侧胶质瘤的手术效果。方法对采用不同手术入路治疗的62例颞叶内侧胶质瘤患者的手术效果进行了分析。62例中肿瘤限局于颞叶内侧结构(A型)33例,其中位于颞叶内侧前部(A1型)19例,病变向颞叶内侧后部生长(A2型)14例;肿瘤广泛侵袭颞叶内侧、岛叶和额眶回后部(B型)9例;肿瘤向颞极和侧脑室颞角外侧侵袭(C型)14例;肿瘤向内侧侵袭脑干、基底节和丘脑(D型)6例。手术入路的选择有3种:经外侧裂入路、经颞叶入路及颞下入路。结果经外侧裂入路25例次,肿瘤全切除14例,近全切除6例,大部切除5例,术后原视觉障碍加重2例。经颞叶入路23例次,肿瘤全切除15例,近全切除5例,大部切除3例,术后原视觉障碍加重5例,新发生视觉障碍4例。颞下入路14例次,肿瘤全切除10例,近全切除4例,术后无发生视觉障碍病例。结论经外侧裂和颞下入路能减少对脑组织和视放射的损伤,而侧方经颞上回、中回入路可能损伤脑组织和视放射。
Objective To investigate the surgical results of resecting the medial temporal lobe gliomas by different surgical approaches. Methods The surgical results of 62 patients with medial temporal lobe glioma treated by different surgical approaches were analyzed. Thirty-two tumors were located in the medial temporal structure (type A) in 62 cases, of which 19 were located in the anterior temporal lobe (type A1) and 14 posterior to the medial temporal lobes (type A2) There were 9 cases in the medial leaf, insula and orbital gyrus (type B), 14 cases invaded to the temporal pole and outside of the lateral horn of the lateral ventricle (C type), and the tumors invaded the brainstem, the basal ganglia and the thalamus ) 6 cases. Surgical approach to the choice of three kinds: the lateral fissure into the road through the temporal lobe approach and infratemporal approach. Results Twenty-five cases underwent lateral cleft approach. Tumor resection was performed in 14 cases, subtotal resection in 6 cases, subtotal resection in 5 cases, and postoperative visual acuity in 2 cases. Twenty-three cases underwent total temporal resection, including 15 cases of total resection, 5 cases of total resection, 3 cases of partial resection, 5 cases of primary visual impairment and 4 cases of new visual impairment. Infratemporal approach 14 cases, total tumor resection in 10 cases, nearly total resection in 4 cases, no postoperative visual impairment cases. Conclusions The lateral and distal infratemporal approach can reduce the damage of brain tissue and visual radiation, while the lateral approach through the temporal gyrus and middle return may damage brain tissue and visual radiation.