【摘要】 目的报告23例视交叉后部病变的手术治疗经验,探讨视交叉后部病变的手术入路和显微手术技巧。方法采用眶额颞-终板入路显微切除视交叉后占位性病变23例,其中颅咽管瘤13例,垂体腺瘤4例,术前诊断未明者6例。结果16例病灶全切除,5例次全切,2例部分切除。15例术中解剖保留垂体柄。术后并发一过性尿崩17例,永久性尿崩1例,视力障碍加重2例。术后15例随访16-48个月,8例随访3-12个月,其中2例复发。结论经眶额颞-终板入路对于视交叉后部病变可提供足够的操作空间,术中显微解剖鞍区各脑池,妥善保护好颅底前循环及其重要穿通支、视通路、垂体柄和下丘脑等,术后可取得良好的临床疗效。更多还原

【Abstract】 Objective To present the experience of microsurgery for removal of retrochiasmatic lesions in 23 cases, and discuss the operative approach and the techniques of surgical treatment. Methods 23 cases suffered from retrochiasmatic lesions with the diameter varied from 2.8cm to 6.5cm, which included 13 cases of craniopharyngioma, 4 cases of pituitary adenoma, and 6 cases of other lesions in our study. The transorbital-subfrontal-temporal craniotomy combined with translamina terminalis approach was used to remove these lesions by microsurgical technique. Results Total resection was achieved in 16 cases, and the tumor was subtotally removed in 5 patients and partially removed in 2 patients. The pituitary stalks were reserved in 15 cases. After operation, 18 cases suffered from diabetes insipidus, 17 cases recovered in 2 weeks after operation among 18cases, and one case continued. Follow-up duration ranged from 16 to 48 months in 15 cases and 3 to 12 months in 8 cases, showed two tumors recurrence, including one patient with hypothalamic glioma died of hyperosmotic coma during follow-up. There were no surgical mortality and severe complications. Conclusions The method of transorbital-subfrontal-temporal craniotomy combined with translamina terminalis approach can provide an excellent exposure to retrochiasmatic region and its surrounding structures. This approach ensures less cerebral retraction for easy access to retrochiasmatic lesion, fenestration of the lamina terminalis is a safe procedure. Reserving the stalk, fenestrative artery, optic nerve and optic chiasm in the microsurgical removal could reduce the incidence of operative complication by experienced microsurgical technique and the translamina terminalis approach, and help to get good outcome.更多还原