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经胼胝体间入路切除侧脑室前部病变后认知功能的变化。

Changes in cognitive function after resection of lesions in the anterior part of the lateral ventricle via an interhemispheric transcallosal approach.

机构信息

The Departments of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan.

The Departments of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan.

出版信息

J Clin Neurosci. 2020 Sep;79:39-44. doi: 10.1016/j.jocn.2020.07.026. Epub 2020 Aug 5.

Abstract

Anterior callosotomy to about 20 mm has been considered relatively safe empirically. The present study aimed to compare cognitive function before and after resection of tumors in the anterior part of the lateral ventricle. We analyzed 6 patients with intraventricular tumors located in the anterior horn or body of the lateral ventricle who underwent surgical excision via interhemispheric transcallosal approach at Osaka City University Hospital between March 2015 and August 2018. And clinical and imaging studies, neuropsychological function using MMSE, WAIS-III and WMS-R and surgical complications were retrospectively reviewed based on the medical records at our institution. As a result, 4 patients achieved gross total resection of the tumor and 2 patients achieved subtotal resection. 4 patients showed hydrocephalus, which disappeared in each case within 6 months after tumor resection. Mean length of callosotomy was 16.9 mm (range, 15.5-26.1 mm). One patient showed postoperative transient deficits including aphasia, microphonia, ballism in all extremities and hemiplegia, and another patient experienced subjective difficulty when talking. These symptoms disappeared within 3 months after tumor resection. Scores from the MMSE and WAIS-III showed no significant postoperative deterioration. Performance intelligence quotient (P = 0.04), full intelligence quotient (P = 0.04) and perceptual organization (P = 0.03) of WAIS-III were significantly improved after surgery compared with preoperatively. In conclusion, anterior corpus callosotomy of about 20 mm for intraventricular tumor in the anterior horn or body of the lateral ventricle might have little effect on cognitive function in the chronic phase, although the influence of hydrocephalus cannot be ignored.

摘要

前连合切开约 20mm 被认为在经验上是相对安全的。本研究旨在比较侧脑室前角或体部肿瘤切除前后的认知功能。我们分析了 2015 年 3 月至 2018 年 8 月期间在大阪市立大学医院通过大脑两半球间经胼胝体入路手术切除的 6 例位于侧脑室前角或体部的脑室肿瘤患者。并根据我院病历回顾性分析了临床和影像学研究、使用 MMSE、WAIS-III 和 WMS-R 进行的神经心理学功能以及手术并发症。结果,4 例患者肿瘤全切,2 例患者次全切除。4 例患者出现脑积水,术后 6 个月内均消失。胼胝体切开的平均长度为 16.9mm(范围,15.5-26.1mm)。1 例患者术后出现短暂性失语、微音、四肢舞蹈症和偏瘫,另 1 例患者出现说话困难。这些症状在肿瘤切除后 3 个月内消失。MMSE 和 WAIS-III 的评分无明显术后恶化。术后与术前相比,WAIS-III 的表现智商(P=0.04)、全智商(P=0.04)和知觉组织(P=0.03)显著提高。总之,对于侧脑室前角或体部的脑室肿瘤,前连合切开约 20mm 在慢性期对认知功能的影响可能较小,尽管脑积水的影响不容忽视。

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