探讨脑室中枢神经细胞瘤显微手术入路的选择及其临床疗效。

选取广州三九脑科医院神经外一科自2011年12月至2019年10月采用显微手术治疗的33例脑室中枢神级细胞瘤患者，对患者的手术入路选择、手术要点、不同手术入路的手术相关情况及术后评分等临床资料进行回顾性分析。

20例患者采取额中回-侧脑室前角入路，10例患者采取三角区造瘘-脑室手术入路，3例患者采取行前纵裂-胼胝体入路。肿瘤完全切除26例，次全切除7例。术后再行脑室-腹腔分流2例，行放射治疗和化学治疗7例。随访6个月~8年，未发现复发病例。3种手术入路患者的手术时间和出血量相比，差异有统计学意义（P<0.05）；纵裂-胼胝体入路的手术时间、出血量均高于额中回入路、三角区入路，差异有统计学意义（P<0.05）。术后3个月，3种手术入路患者卡氏评分比较，差异无统计学意义（P>0.05）。

根据脑室中枢神经细胞瘤的病灶特点，选择合适的手术入路有助于手术全切脑室中枢神经细胞瘤，术后配合放射治疗和化学治疗可改善患者的预后。

To explore the selection of microsurgical approach for neurocytoma and the analysis of clinical treatment and clinical effect.

Thirty-three cases were treated by microsurgery from December 2011 to October 2019 in the First Department of Neurosurgery, Guangzhou 999 Brain Hospital. The clinical data of surgical approach selection, the key points of the surgery, the surgery related conditions of different surgical approaches and postoperative scores were analysis.

There were 20 cases treated by the approach of the superior frontal gyrus-lateral ventricle anterior horn, 10 cases treated by the approach of triangular-ventricular and 3 cases treated by the approach of the anterior longitudinal fissure-corpus callosum. Twenty-six cases were resected completely and 7 cases were resected subtotally. Two cases were treated by ventricular-abdominal shunt after operation, and 7 cases were received radiotherapy and chemotherapy. All cases were followed up for 6 months to 8 years, and no recurrence case was found. In the three surgical approaches, the difference between the operation time and the volume of bleeding was statistically significant (P<0.05); the operation time and the bleeding volume of the longitudinal fissure-corpus callosum approach was higher than those of the middle frontal gyrus approach and the triangle approach, the difference was statistically significant (P<0.05). Three months after operation, the Karnofsky scores in the three groups of patients were not significantly different (P>0.05).

According to the characteristics of the lesion, it may be helpful for the resection completely for the treatment of central neurocytoma in ventricle by choosing the appropriate surgical approach. Furthermore, it should improve the prognosis of patients by combination of radiotherapy and chemotherapy after surgery.