目的 探讨影响经改良Poppen入路显微切除成人松果体区肿瘤患者预后的影响因素,以期发现导致患者预后不良的相关因素,改善患者临床预后.方法 收集中国科学技术大学附属第一医院神经外科自2015年6月-2020年7月收治并行经改良Poppen入路显微切除成人松果体区肿瘤患者临床资料,回顾性分析上述资料.结果 共纳入患者48例,患者于术后1个月行卡诺夫斯凯计分(KPS)评分,根据KPS评分结果将患者分为2组(以KPS评分70及以上为预后较好,KPS评分70分以下为预后较差,因KPS评分70分以下患者有效的抗肿瘤方案无法实施).其中预后较好患者29例,预后较差患者19例.在2组患者的单因素分析比较中,预后较差组出血量[(466.84±182.18)mL]多于预后较好组[(364.14±123.42)mL]、预后较差组术后枕叶损伤发生率(57.89％,11/19)高于预后较好组(24.14％,7/29);多因素logistic回归分析结果提示患者术后KPS评分仅与患者术后出现枕叶损伤(OR=4.887)、病变与顶盖关系相关(OR=5.870),与术前患者KPS评分及术中出血量无关.结论 研究显示改良Poppen入路进行脑肿瘤的显微外科切除能够改善患者预后,部分患者预后较差与患者肿瘤位置、术后枕叶是否损伤以及出血量多少有关.手术中应避免过度牵拉,降低枕叶损伤可能;对于肿瘤位于顶盖前方患者考虑更换手术方式;术中降低总出血量可能改善患者预后.

Objective: The pineal region is deep, and anatomical relationship is complex. Imaging evaluation can effectively guide all kind of neurosurgery. The aim of this study was to explore the value of image evaluation in pineal region microsurgery via modified Poppen approach. Methods: From January 2008 to December 2017, the imaging and clinical data form 62 patients received microsurgery of pineal lesions via the modified Poppen approach at our Hospital were reviewed. The incidences of postoperative complications were compared between the patients with differences in lesion diameter, tentorial angle and preoperative hydrocephalus. Result: According to the data from image evaluation, all the pineal lesions was removed through modified Poppen approach, with total tumor resection in 48 cases, subtotal resection in 10 cases, and partial resection in 4 cases. After 3 to 12 months follow-up, the complication was found in 13 cases (21.0%), including hemianopia (2 cases), occipital lobe contusion (7 cases), monoparesis (2 cases), intracranial infection (2 cases). The incidences of postoperative hemianopia and monoparesis for patients with a lesion > 4.5 cm were significantly higher than those with a lesion ≤ 4.5 cm (P < 0.05). The incidence of postoperative hemianopia for the patients with a tentorial angle > 60° was significantly higher than for those with a tentorial angle ≤ 60° (P < 0.05). Conclusion: Imaging evaluation is useful for microsurgical removal and prediction of complication for modified Poppen approach of pineal lesions.

松果体区肿瘤发病率低,但组织类型多样,位于大脑深部,与许多重要血管及组织结构密切相连,手术难度大.目前主要的治疗方法是通过显微手术切除松果体区病灶,其中改良Poppen入路利用大脑深静脉系统形成的生理间隙获取良好手术视野,因操作直观,入路距离短且大大提高了肿瘤的全切率得到广泛应用.本文从Poppen入路的显微解剖及静脉间隙、临床应用、术后常见并发症及优缺点等方面进行综述.

目的 探讨经改良Poppen入路显微切除成人松果体区肿瘤的经验和疗效.方法 安徽医科大学附属省立医院神经外科自2013年8月至2018年1月采用改良Poppen入路切除成人松果体区肿瘤25例,回顾分析25例患者的临床资料和随访结果.结果 本组患者中肿瘤全切除21例(84％),次全切除3例(12％),部分切除1例(4％).术后并发枕叶挫伤2例,同向性偏盲4例,眼球运动障碍3例,颅内感染1例,无手术死亡病例.1例患者术后半年行脑室-腹腔分流术,多数患者术后临床症状有不同程度改善.结论 采用改良Poppen入路切除松果体区肿瘤可获得充足的视野及操作空间,更好地提高手术安全性,降低并发症发生率.