| Objective:To investigate the strategies and methods for improving the microsurgical tr eatment of the tumor of lateral ventricle and improve the therapeutic effect.Methods:A retrospective analysis of 18 patients with the atrium of lateral ventricle a fter surgical treatment in the first affiliated hospital of kunming medical univer sity from February 2016 to March 2017.Which combined with our complete pr eoperative and postoperative imaging data and confirmed by pathology in 14 c ases with meningioma,2 cases of ependymoma,2 cases of astrocytoma patients.The clinical symptoms with postural changes occurred in 6 cases of patients with headache and vomiting were the main symptoms,4 cases of epilepsy pati ents,and 4 patients with decreased visual acuity,1 patient with progressive uni-lateral limb strength decreased,Two patients were diagnosed with tumor after a minor head injury,and one case was diagnosed after a memory impairment.I ndividualized according to tumor imaging characteristics and location set to cho ose the best surgical approach and strategy of comprehensive treatment,resecti-on of tumor used to choose the right means of excision,incision extending dir ection of the order and cortex.Among them,6 cases were used in the middle f rontal gyrus approach,10 cases were in the upper occipital approach,and 2 w ere in the parietaloccipital gyrus approach.After the operation,the patients wer e followed up by telephone,outpatient consultation and email to observe the f unctional recovery of the nervous system and the new neurological dysfunction.Results:In this group,18 cases of lateral ventricle tumors were located in 5 of the dominant hemisphere and 13 in the non dominant hemisphere.Of which 14 c ases of meningioma,6 cases were male and 8 were female,age 22～63 years,average 48.2 years old,10 cases trigone of lateral ventricles,1 cases of frontal angle,occipital angle in 2 cases,1 cases of body;There were 2 cases of epe ndymoma,33 years old male and 36 years old female,including 1 cases of 1 ateral ventricle body and 1 case of interventricular orifice.There were two cas es of astrocytoma,21 years old and 30 years old male,respectively,and the t umor was located in the hemispherical ventricle.The microscopy can show cle ar and accurate positioning of the lesion.The tumor resection was good under the microscope,13 cases were cut,4 cases were subtotal,and 1 case was rese cted,and the total tumor rate was 72.2%.6 cases were used in the middle fron tal gyrus approach(lateral ventricle frontal meningioma superior hemisphere in 1 cases,lateral ventricle in the non-dominant hemisphere 1 case);1 case of sup erior hemisphere of ependymoma,1 cases of non-dominant hemispheres.The a dvantages of astrocytoma and 1 case of non-dominant hemispheres;In 10 cases,the temporal occipital approach was used(5 cases in the non-dominant hemis phere and 3 in the dominant hemisphere).Two cases of cerebral ventricular me ningioma in hemihemispheric lateral ventricle.2 cases were applied with the su perior temporal gyrus approach.(2 cases of meningioma in the dominant hemis pherical region).Postoperative pathological results:10 cases of fibrinoid mening ioma,3 cases of sand granule meningioma,1 case of epithelial cell meningiom a,1 case of diffuse astrocytoma and mesenchymal astrocytoma.The microsurgical treatment in this group did not lead to death,and the clin ical symptoms and signs of the 16 patients were significantly better than befor e.Postoperative complications occurred after treatment.Two patients had a transie nt aphasia and dyslexia.In one case,there was a transient ocular movement di sorder.In 2 patients,there was a mild hemiplegia and partial depth perception d isorder.The symptoms of 5 patients with increased intracranial pressure were ba sically disappeared,and 2 cases were improved in the first 3 cases of the sam e direction,and 2 cases were new.In 4 patients with epileptic seizures,1 case was improved after surgery,and 2 cases of new cases were controlled after 6 months of antiepileptic treatment.Three of the four patients with vision loss i mproved after surgery.1 case with progressive unilateral limb strength decreased the preoperative muscle strength IV,postoperative auxiliary physical therapy a nd other measures to restore the muscle strength to V level.Two cases of centr al nervous system infection were recovered after active anti-infection treatment.The postoperative symptoms of obstructive hydrocephalus in 1 patient were im proved after surgery.In 2 cases,the hematoma was removed after operation.Aft er the operation,11 patients returned to normal life and work,5 patients were able to live independently,and 2 patient needed help in life.Four patients wer e followed by imaging findings and the tumor recurred after 1 year.The clinica 1 symptoms of postoperative patients were significantly improved compared wit h those before surgery,and all 16 cases of KPS score were above 70.With the progress of the surgery,intraoperative improve the precision of the operation,effectively reduce the brain injury,hemorrhage and trauma,the contralateral me ningeal venous drainage system to achieve maximum protection of brain functi on and the best therapeutic effect.Conclusion:Before operation,we should fully understand the anatomical position of the t umor in the lateral ventricle,the adjoining relationship,the blood supply and t he combination of hydrocephalus.The correct choice of surgical approach can re duce the disability rate and obtain good curative effect.Positive and correct trea tment strategies can improve the prognosis of lateral ventricle tumors.In the pr ocess of microsurgical resection,it is necessary to have adequate operation spa ce and reduce the traction of the brain tissue to ensure better exposure of the tumor and the blood supply artery is the key to surgical resection of the tumor.Parietaloccipital gyrus approach is suitable for this study in advantage hemisph ere or large tumors,the into surface of tumor,path,small damage in brain tiss ue,the operation area in the rear of the sensorium,above to avoid damage to the angular gyrus and Sensory language dysfunction However,it may not be p ossible to expose the blood supply artery before the tumor resection,which ma y result in epilepsy,mild hemiplegia,or homotopia.A tumor tissue located in the frontal and body parts of the lateral ventricle was suitable for resection.The cortical incision was parallel to the apparent radiation,and there were few vis ual field defects.At the same time,the anterior and posterior arteries of the ch oroid can be effectively exposed to control bleeding,and can be combined into the operation when necessary.However,it may damage the motor language cen ter(Broca area),the writing center in the middle frontal gyrus and the cortical side area,which can cause speech disorder,dysgraphia and eye movement dis order.The temporal approach as soon as possible can be exposed to the suppl y of the tumor before the choroid artery,can effectively reduce the intraoperati ve bleeding,postoperative probably because of injury but the visual language c entre of postoperative radiation hemianopsia or damage Wernicke area.named a phasia and reading dysfunction may occur.In the case of individualized tumor,it is necessary to correctly select the surgical approach,determine the directio n of the cortical incision and the surgical channel,and carefully probe into the location of the tumor.The surgical pathway of the formation of the rules prev ents severe damage to the cerebral cortex and nerve fiber bundles,and reduces the time of operation.To reduce postoperative brain tissue edema,neurological impairment and other complications.In particular,the appropriate surgical appro ach was chosen to expose the tumor dorsal blood supply and to make accurate judgment and treatment,so as to reduce the traction of brain tissue in order t o ensure sufficient operation space.Therefore,the selection of appropriate surgic al approach has important clinical value in microsurgical resection. |
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