corpus callosum and septum pellucidectomy

There are fewer tumors that occur in the corpus callosum and clear septum, especially those with primary corpus callosum. Among the tumors here, there are many astrocytomas, most of which are invaded into the corpus callosum by one side of the cerebral hemisphere, and develop to the contralateral hemisphere, sometimes extensively infiltrating the transparent septum, basal ganglia or periventricular white matter. Carcass lipoma, since the first report of Rokitansky in 1856, has been reported at home and abroad. Tuberculoma, epithelioid cysts, and dermoid cysts can also be seen here. Atrial astrocytoma and gel-like cysts and transparent septum cysts occur in the transparent septum, which is easy to extend to the lateral ventricle, so the tumor body occupies the anterior part of the lateral ventricle. Clinical manifestations and diagnostic criteria: Therefore, the occupying lesions are located in the midline and often have no symptoms and signs in the early stage. Carcass tumors, such as invading the bilateral frontal lobe, are often characterized by mental symptoms and mental retardation, such as apathy, slow response, no desire, and memory loss. If the tumor is compressed or blocked in the third ventricle or aqueduct, symptoms of high blood pressure may occur. If the tumor invades adjacent structures, corresponding focal symptoms and signs such as sputum, sensory disturbance, pyramidal tract sign, aphasia, and disuse may occur. In the early stage of the tumor in the transparent compartment, the interventricular space can be filled, and symptoms of hydrocephalus and intracranial hypertension appear. Auxiliary examination: cerebral angiography is mainly characterized by periorbital artery separation and uplift, and ventriculography positive image shows compression or arcuate depression on both sides of the ventricle. In the clear septum, there are bilateral ventricular separation and filling defects at the tumor. After CT and MRI are applied to the clinic, the diagnostic rate is improved, the method is simple and no damage to the patient. The glioma can display high-density or iso-density images on the CT slice in the corpus callosum. The lipoma shows low-density lesions and calcification in the periphery. ring. Treating diseases: astrocytoma Indication 1. Limit the tumor to the body. 2. Steroidal tumor with manifestations of intracranial hypertension. 3. Transparent septum cyst with cranial hypertension. 4. Transparent tumor. Contraindications 1. Invasive corpus callosum in the advanced stage, the patient can not bear the operator. 2. The corpus callosum lipoma is asymptomatic or only has seizures, and the frequency is infrequent. 3. Transparent septum cyst, no lateral ventricle enlargement and manifestations of intracranial hypertension. Preoperative preparation 1. Patients with hydrocephalus with hydrocephalus continue to drain the ventricle before surgery. 2. Prepare microsurgical instruments. Surgical procedure 1. scalp incision and craniotomy The right frontal midline cutaneous flap is usually used in the anterior aspect of the corpus callosum and the transparent septal tumor. Most of the tumors in the posterior part of the corpus callosum and the compression part were treated with the right occipital midline cutaneous flap. The medial part of the scalp incision can be located in the sagittal midline, or slightly above the midline. The medial two bone holes of the midline side bone flap can be 1 to 1.5 cm from the midline. After the bone flap is opened, the medial edge of the bone window is enlarged with a rongeur until the edge of the superior sagittal sinus is limited. 2. Dural incision Make a hard meningeal flap and turn to the sagittal sinus side. For example, if there is bleeding or oozing between the epidural and sagittal sinus, a gelatin sponge may be filled, and the outer layer of the dura mater is sutured with the periosteum or the cap aponeurosis by a thin wire. 3. Exposing and excising tumors in the corpus callosum Central veins and other large bridge veins should be avoided. However, the small bridge vein entering the sagittal sinus on the surface of the cerebral cortex can be electrocoagulated and cut off. Use a wet cotton pad to properly protect the central vein to avoid contralateral hemiplegia after injury. The inner side of the brain is pulled outward from the longitudinal slit with a serpentine fixed retractor to reveal the cerebral palsy. Under the armpits of the brain, the tumor can be seen to bulge upward from the corpus callosum, and the texture of the tumor can be examined, with or without the capsule and boundary, and adhesion to the periorbital and temporal artery of both sides. Glioma is mostly invasive growth, with no clear boundaries, and can only be partially and mostly removed. Although the lipoma is benign, the dense fibrous tissue is closely connected with the surrounding structure, and the exfoliation is extremely difficult. The total tumor is highly damaging and can only be partially or partially resected. Carcass tumors can be seen under the armpits of the brain. The blood vessels on the surface of the tumor or the capsule can be electrocoagulated and then removed in the capsule or in sections, and the whole tumor or partial resection can be performed according to the nature of the tumor. If no tumor is seen in the longitudinal fissure, the arachnoid of the corpus callosum can be opened according to the lower edge of the cerebral palsy to reveal the corpus callosum. In the anterior and body parts of the corpus callosum, care should be taken to protect the bilateral periorbital arteries and their branches. In the posterior and compressed parts of the body, it is necessary to carefully recognize the relationship between the direction of the internal veins of the brain and the large cerebral veins and the tumor, and properly protect them. Confined to the tumor in the corpus callosum, after most or part of the resection, if necessary, do not open the third ventricle and pay attention to protect the important structures around. 4. Transparent tumor resection and excision The method of incision into the anterior horn of the lateral ventricle through the frontal cortex is used, and the anterior horn of the ventricle can be used to cut into the anterior horn of the lateral ventricle. When the anterior horn is opened, the tumor can be seen, and the interventricular pores are often blocked by the tumor. Glioid cysts, clear septum cysts, and ependymoma can be completely cut. Astrocytoma and the surrounding structure are unclear, and most of them can only be removed. At present, the third intraventricular cyst is also removed by endoscopy. 5. Guan skull The dura mater is tightly sutured, the bone flap is reset, the dura mater is externally hollowed out, and the cap aponeurosis and skin are sutured. complication Ventricular inflammation Caused by postoperative infection or tumor cyst fluid stimulation, in addition to the use of antibiotics to control infection, multiple lumbar puncture can understand the condition and relieve symptoms. 2. Neurological dysfunction The important functional area of the injury or its conduction beam can produce hemiplegia, aphasia and homonymous hemianopia. Apply neurometabolism drugs and strengthen functional training.

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