Silva Pedro Santos, Cerejo António, Polónia Patrícia, Pereira Josué, Vaz Rui
Neurosurgery Department, Hospital de São João, Porto, Portugal.
Clin Neurol Neurosurg. 2013 Sep;115(9):1745-52. doi: 10.1016/j.clineuro.2013.04.010. Epub 2013 May 7.
The trans-lamina terminalis (TLT) approach to the suprasellar region and third ventricle is complex, with risks of visual and hormonal deficits. However, the postoperative deficits might not be directly related to opening of the lamina terminalis but to the close relationship of tumours with vital neural and vascular structures. The analysis of results using this approach was the objective of this study.
The TLT approach was used in 29 patients (18 craniopharyngiomas, 5 astrocytomas, 5 germinomas and 1 ganglioglioma). The extent of tumour removal, mortality and morbidity (especially visual or hormonal deficits) were studied.
Complete tumour removal was achieved in 15 patients, subtotal extensive removal (more than 90%) in 9 cases and partial removal in 5 cases. Panhypopituitarism developed in 22 patients. Total tumour removal was associated with the development of endocrinological disturbances. There was worsening or the onset of new visual field defects in 4 cases. Postoperative endocrine and visual deficits were in the range generally described regarding surgery for tumours in this region.
The TLT approach allows for extensive removal of third ventricle and suprasellar tumours, without increased risks of visual and hormonal deficits, compared to those described regarding surgery for lesions in this region.
经终板入路处理鞍上区和第三脑室较为复杂，存在视力和激素缺乏的风险。然而，术后的功能缺失可能并非直接与终板打开相关，而是与肿瘤和重要神经血管结构的紧密关系有关。本研究的目的是分析采用该入路的手术结果。
对29例患者采用经终板入路（18例颅咽管瘤、5例星形细胞瘤、5例生殖细胞瘤和1例节细胞胶质瘤）。研究肿瘤切除范围、死亡率和发病率（尤其是视力或激素缺乏）。
15例患者实现了肿瘤全切，9例次全广泛切除（超过90%），5例部分切除。22例患者发生垂体功能减退。肿瘤全切与内分泌紊乱的发生相关。4例出现视野缺损加重或新的视野缺损。术后内分泌和视力缺损在该区域肿瘤手术通常描述的范围内。
与该区域病变手术的相关报道相比，经终板入路能够广泛切除第三脑室和鞍上肿瘤，而不会增加视力和激素缺乏的风险。
