中文摘要：

目的探讨改善侧脑室内脑胶质瘤显微外科手术治疗的策略和方法，提高治疗效果。方法回顾性分析自2000年1月至2007年6月在我院治疗并经病理证实的23例侧脑室脑胶质瘤患者的临床表现、诊断和显微外科手术治疗方式。临床以头痛等颅内压增高为主要症状者15例，以进行性单侧肢体肌力减退起病者4例，以记忆力下降起病者5例，以癫痫起病者2例。根据肿瘤影像学特点和病理性质选择最佳手术入路和综合治疗策略。6例选择经纵裂胼胝体前部入路，5例经额中回皮层脑室入路，4例经纵裂胼胝体前部联合额叶皮层入路切除前角和体部位置较前的肿瘤，7例经顶叶皮层入路切除三角区及体部位置偏后的肿瘤，1例经枕叶皮层入路切除枕角肿瘤。6例应用术中导航定位，4例应用术中B超监测。术后病理证实为胶质瘤且级别在Ⅱ级以上者行化疗和放疗，化疗方案为卫萌-26＋氯乙环已亚硝脲（甲基-CCNU），放疗方案根据胶质瘤病理级别和范围进行个体化设定。采用电话、门诊及邮件等方式进行随访。结果在显微外科治疗的79例侧脑室肿瘤中23例术后病理证实为脑胶质瘤，其中星形细胞瘤11例，少突胶质细胞瘤6例，中枢神经细胞瘤4例，室管膜瘤2例。肿瘤主体位于侧脑室前角和体部15例，位于三角区及后角8例。显微镜下全切除肿瘤15例，次全切除肿瘤6例，部分切除肿瘤2例。术后临床症状改善18例，较术前加重2例，无明显变化3例，因肺部感染并发症死亡1例。随访显示存活1年以上有17例，术后1年内死亡6例。结论侧脑室胶质瘤术前应充分了解肿瘤在侧脑室解剖位置、毗邻关系、血供及是否合并有脑积水等，正确选择手术入路可降低致残率而取得良好疗效。导航辅助或B超实时监测技术结合显微外科手术有助于提高肿瘤的切除程度，采取积极正确的治疗策略?

英文摘要：

Objective To enhance the therapeutic effects through ameliorating the microsurgical strategies and methods of lateral ventricle gliomas. Methods The clinical manifestations, diagnoses and microsurgical approaches of 23 patients, who were treated in our hospital during January 2000 and June 2007 and pathologically diagnosed as lateral ventricle gliomas, were retrospectively analyzed. Clinical data included 15 cases of raised intracranial pressure with the primary symptom of headache, 4 cases of progressive unilateral limb muscle strength decline, 5 cases of memory descent and 2 cases of epilepsy. The optimal surgical approaches and comprehensive therapeutic strategies were selected according to the imaging features and pathological properties of tumors. Resection was performed via the anterior transcallosal approach in 6 cases, the transcortical approach in 5 cases, the combined interhemispheric transcallosal and transcortical approach in 4 patients to remove tumors in the anterior horn and anterior body of the lateral ventricle, the transparietal cortical approach in 7 patients to remove tumors in the trigone or posterior body of the lateral ventricle, and the transoccipital cortical approach in 1 case. The navigation orientation was used in 6 cases and supervision by type-B ultrasonic, in 4 cases. Patients with tumors above grade Ⅱ, confirmed pathologically after resection, underwent chemotherapy （Vumon＋ lomustine/methyl-CCNU） and radiotherapy which was designated individually according to the pathological grades and scope of gliomas. The follow-up study was conducted by telephone, e-mail or outpatient department visits etc. Results A total of 23 of the 79 cases undergoing microsurgical treatment for their lateral ventricle tumors were pathologically confirmed as cerebral gliomas after resection, including astrocytomas in 11 cases, oligodendrogliomas in 6 cases, central neurocytomas in 4 cases and ependymomas in 2 cases. Tumors in the anterior horn and body of the lateral ventricle were found in 15 cases