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首页> 外文期刊>Neurosurgery >Surgery for temporal mediobasal tumors: experience based on a series of 235 patients.
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Surgery for temporal mediobasal tumors: experience based on a series of 235 patients.

机译：颞中叶肿瘤的手术：基于235例患者的经验。

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OBJECTIVE: To describe the clinical characteristics, diagnosis, various approaches, and outcomes in a retrospective review of a large series of temporomediobasal (TMB) tumors. METHODS: Charts from 235 patients with TMB tumors were identified from the glioma and epilepsy surgery database and from the electronic operations log. Preoperative magnetic resonance imaging scans were available for all patients and postoperative follow-up was available for 155 of these patients (mean follow-up period, 59 mo; range, 2-172 mo). Preoperative symptoms, approaches, technical problems, and surgical complications are described. RESULTS: Two hundred and thirty-five patients with intra-axial TMB tumors (mean age, 35 yr) were collected during an 11-year period. The largest tumor groups were astrocytomas (38.0%), gangliogliomas (29.8%), dysembryoplastic neuroepithelial tumor (11.1%), and glioblastomas (11.1%). The most frequent tumor location was the mesial Type A tumor (45.1%), with this type also showing the highest proportion of benign (World Health Organization Grades I and II) histological features (91.3%). Of all tumors, 76.2% were benign. Larger tumor size was associated with higher frequency of malignant histopathological findings. The leading symptom was epilepsy in 91% of patients, followed by drug-resistant epilepsy in 71.5%. Significant preoperative neurological deficits, such as hemiparesis or aphasia, were seen in 3.8% of the patients; another 12% had visual field deficits. Thirty-eight patients with low-grade tumors had undergone surgery previously. Several surgical approaches were chosen: transsylvian in 28%, anterior two-thirds temporal lobe resection in 23%, temporal pole resection in 15.3%, subtemporal in 19%, and transcortical in 6%. The most frequent neurological complications were transient: dysphasia (4.2%), hemiparesis (5%), and oculomotor disturbance (2.5%). Permanent nonvisual neurological complications occurred in fewer than 2% of the patients and significant new hemianopic defects were found in another 5.4% of the patients. The most severe complication was one intraoperative internal carotid artery lesion. One patient died. CONCLUSION: Small tumor size, magnetic resonance imaging, and microsurgery have made resection of mostly benign TMB tumors possible in a large number of patients. This series supports the conclusion that these tumors can be operated on with a relative degree of safety for the patient, provided that the anatomy of the mesial temporal lobe and the variety of approaches are well known to the surgeon. However, because of the complex anatomic structures in the vicinity, transient neurological deterioration is not infrequent and certain neurological disturbances (e.g., quadrantanopia) even seem to be unavoidable, whereas permanent significant deficits are rare.
机译：目的：通过回顾性分析一系列颞颞基底（TMB）肿瘤的临床特征，诊断，各种方法和结果。方法：从神经胶质瘤和癫痫手术数据库以及电子手术日志中识别出235例TMB肿瘤患者的图表。所有患者均可进行术前磁共振成像扫描，其中155例患者可进行术后随访（平均随访时间为59 mo;范围为2-172 mo）。描述了术前症状，方法，技术问题和手术并发症。结果：在11年期间收集了235例轴内TMB肿瘤患者（平均年龄35岁）。最大的肿瘤组是星形细胞瘤（38.0％），神经胶质瘤（29.8％），胚性增生性神经上皮肿瘤（11.1％）和胶质母细胞瘤（11.1％）。肿瘤位置最频繁的是中型A型肿瘤（45.1％），其中这种类型的组织学特征也显示出最高比例的良性（世界卫生组织I级和II级）（91.3％）。在所有肿瘤中，76.2％为良性。较大的肿瘤大小与较高的恶性组织病理学发现频率相关。主要症状是癫痫患者占91％，其次是耐药性癫痫患者占71.5％。 3.8％的患者出现术前严重的神经功能缺损，如偏瘫或失语。另外12％的人有视野不足。 38例低度肿瘤患者以前曾接受过手术。选择了几种外科手术方法：经椎管切除术占28％，前三分之二的颞叶切除术占23％，颞极切除术占15.3％，颞下颞叶切除术占19％，经皮层切除术占6％。最常见的神经系统并发症是短暂的：吞咽困难（4.2％），偏瘫（5％）和动眼障碍（2.5％）。不到2％的患者发生了永久性非视觉神经系统并发症，另外5.4％的患者发现了明显的新的偏盲。最严重的并发症是术中颈内动脉病变之一。一名病人死亡。结论：小的肿瘤尺寸，磁共振成像和显微外科手术已使许多患者可以切除大部分良性TMB肿瘤。该系列支持以下结论：只要外科医生了解颞中叶的解剖结构和各种方法，就可以以相对安全的程度对患者进行手术。然而，由于附近复杂的解剖结构，短暂的神经系统恶化并非罕见，某些神经系统疾病（例如，象限象限）似乎是不可避免的，而永久性的明显缺陷很少见。

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