背景:侧脑室肿块的手术方法的选择包括由于其深度定位而造成的困难,靠近血管和雄辩的大脑结构。在侧脑室肿块的手术治疗中应选择最合适的方法仍然存在争议。在这项研究中,研究了选择侧脑室肿块手术入路的因素及其结果。
方法:在本研究中,回顾性分析2002-2013年间80例因侧脑室肿块在我院接受手术治疗的患者。所有病例在术前和术后均根据临床和神经放射学结果进行评估。在24例中,前半球间跨call,在4例中,后半球经call,在30例后半球前骨,经皮质14例,联合手术8例。
结果:病例的性别分布为男性45/女性35,平均年龄为31.7岁(7个月-73岁)。64例患者进行了全切除,而在16例患者中,由于雄辩的脑区浸润而进行了次全切除术。在组织病理学检查中;52神经上皮,8混合神经胶质,3脑膜,2淋巴造血系统,1个松树母细胞瘤,1个生殖细胞,观察到5个转移和8个其他良性肿块。手术后,9例患者出现额外的神经功能缺损。6例患者术后死亡。平均随访时间13(1~83)个月。
结论:影响侧脑室肿块手术治疗效果的主要因素是:组织病理学,location,扩展,以及与神经血管结构的关系。手术的目的是提供组织病理学诊断,总切除,如果可能的话,并通过消除压力的质量效应来使脑脊液的流量正常化。
BACKGROUND: The selection of surgical approach to the lateral ventricular masses includes difficulties due to their deep localizations, close proximity to the vascular and the eloquent brain structures. The most appropriate approach that should be chosen in surgical treatment of lateral ventricular masses is still controversial. In this study, the factors in the choice of surgical approach to the lateral ventricle masses and the results of them were investigated.
METHODS: In this study, 80 patients who underwent surgery in our clinic due to the lateral ventricular masses were retrospectively analyzed between the years 2002-2013. All of the cases were evaluated in terms of clinical and neuroradiological results pre and postoperatively. In 24 cases the anterior interhemispheric transcallosal, in 4 cases the posterior interhemispheric transcallosal, in 30 cases the posterior interhemispheric precuneal, in 14 cases the transcortical and in 8 cases the combined surgical approaches were performed.
RESULTS: Gender distribution of the cases were 45 male/35 female and the mean age of them was 31.7 years (7 month - 73 years). In 64 patients the gross total resection was performed, whereas in 16 patients subtotal resection was performed due to the infiltration of eloquent brain areas. In the histopathological examination; 52 neuroepithelial, 8 mixed neuroglial, 3 meningeal, 2 lympho-hematopoietic system, 1 pine blastoma, 1 germ cell, 5 metastatic and 8 other benign masses were observed. After surgery, additional neurological deficits developed in 9 patients. The mortality was observed in 6 patients postoperatively. The average follow-up time was 13 (1-83) months.
CONCLUSIONS: The essential factors which affect the results of surgical treatment of lateral ventricular masses are; the size of the mass, histopathology, location, extension, and the relationship to the neurovascular structures. The goal of surgery is to provide the histopathological diagnosis, gross total resection, if it is possible, and to normalize the flow of cerebrospinal fluid by eliminating the mass effect of pressure.