摘要
目的探讨无持续牵拉手术在侧脑室中枢神经细胞瘤切除中的可行性、优点及意义。方法回顾性分析36例侧脑室中枢神经细胞瘤病人的临床资料,25例肿瘤主体生长在室间孔附近,11例主体生长在侧脑室体部。手术经皮质额角入路31例,经纵裂胼胝体入路5例。术中不使用脑固定牵开器或者脑压板持续牵拉。术后评价肿瘤切除程度、神经功能损伤及并发症等情况。结果术后MRI证实手术全切除35例,部分切除1例。术后偏瘫4例,反应减慢10例,记忆力下降13例。偏瘫在术后2周均明显恢复,反应及记忆力下降在术后1个月逐步好转。另外术后再次发生脑积水2例(5.6%),观察3个月自行缓解。无脑内血肿、硬膜下积液和皮下积液发生。随访1~3年,均未见肿瘤复发,其中8例病人行放射治疗。结论采用无持续牵拉手术进行侧脑室中枢神经细胞瘤切除,可以充分暴露肿瘤及方便手术操作,并减少因术中牵拉导致的神经功能损伤。
Objective To investigate the feasibility, advantage and significance of no continuous traction in resection of central neurocytoma in the lateral ventricle. Methods Clinical data of 36 patients with central neurocytoma in the lateral ventricle were analyzed retrospectively, including 25 main tumors near to the interventricular foramen and 11 in the body of lateral ventricle. Thirty-one patients underwent surgery via the transcortical frontal horn approach and 5 via interhemispheric transcallosal approach. The brain self-retaining retractor or continuous traction with a brain spatula were not allowed during the surgery. The extent of tumor resection, postoperative neurological deficits and complications were evaluated. Results Total resection was achieved in 35 patients and subtotal resection in 1 patient. Immediate postoperative complications included paralysis in 4 patients, slow reaction in 10 and memory deterioration in 13. All the patients with paralysis recovered in 2 weeks after surgery, and the reaction and memory were improved in 1 month after surgery. The postoperative hydrocephalus occurred in 2 patients （5.6%）, who had spontaneous remission 3 month after surgery. There were no intracranial hematoma, subdural effusion and subcutaneous hydrops. All the patients were followed up for 1 to 3 years and no tumor relapse occurred. Eight patients received radiotherapy. Conclusions Application of no continuous traction in the resection of central neurocytoma in the lateral ventricle can expose the tumor completely and make the operation convenient. And this technology could decrease the occurrence of postoperative neurological deficits secondary to the retraction injury.
出处
《中国微侵袭神经外科杂志》
CAS
2017年第7期319-321,共3页
Chinese Journal of Minimally Invasive Neurosurgery
关键词
脑肿瘤
侧脑室
神经细胞瘤
中枢
无持续牵拉
brain neoplasms
lateral ventricle
neurocytoma,central
no continuous traction
