鞍结节脑膜瘤的手术入路选择及显微手术切除

目的 报道鞍结节脑膜瘤手术治疗的入路选择及显微手术的临床效果。方法回顾分析鞍结节脑膜瘤29例的临床资料，29例鞍结节脑膜瘤分别经额下、翼点或额下翼点联合入路，采用显微手术方法切除肿瘤。结果29例均采用显微手术治疗，全切除27例，大部分切除2例，无死亡。28例术后视力得到满意的恢复。结论选择正确的手术入路和采用显微手术治疗鞍结节脑膜瘤，可明显提高临床疗效。     

脑肿瘤

颅咽管肿瘤的手术入路选择及显微手术治疗；经眶上匙孔入路切除鞍结节脑膜瘤；经蝶窦入路显微切除垂体腺瘤；第四脑室肿瘤的诊断和显微外科治疗；大型嗅沟脑膜瘤的显微外科治疗[编者按]     

翼点入路治疗鞍区脑膜瘤

目的 探讨显微手术治疗鞍区脑膜瘤的方法。方法 回顾性分析了23例鞍区脑膜瘤的临床表现、诊断和显微外科治疗结果，采用经翼点入路显微外科治疗。结果 全切17例，大部切除6例。随访1个月～6年，平均19.1个月，22例恢复良好，随访期间3例复发。结论 选择合适的手术入路，应用显微外科技术，是鞍区脑膜瘤全切并取得良好效果的关键。     

翼点入路显微手术切除巨大型鞍结节脑膜瘤

目的总结经翼点入路显微手术切除巨大鞍结节脑膜瘤的经验. 方法 2000年2月～2004年11月我院应用显微外科技术,治疗巨大鞍结节脑膜瘤18例.偏侧生长的肿瘤选择翼点入路,先处理肿瘤基底减少血供,再充分利用鞍区脑池及肿瘤与周围结构之间的蛛网膜界面,在保护好重要结构的前提下最大限度地切除肿瘤. 结果全切除16例(88.9%),次全切除2例(11.1%),无一例手术死亡.14例随访3个月～4年,平均2.5年,肿瘤无复发. 结论翼点入路可对中颅窝、鞍区病变进行良好暴露,提高巨大型鞍结节脑膜瘤全切除率.     

经纵裂入路显微切除术治疗鞍结节脑膜瘤效果观察

目的观察经纵裂入路显微切除术治疗鞍结节脑膜瘤的效果。方法将2011-01—2015-12间佛山市高明区人民医院收治的46例鞍结节脑膜瘤患者随机分为2组,各23例。对照组采用额下入路显微切除术,观察组采用经纵裂入路显微切除术。比较2组患者治疗前后昏迷评分、有效率及并发症发生率。结果治疗前2组GCS评分差异无统计学意义(P0.05)。治疗后观察组GCS评分优于对照组,差异有统计学意义(P0.05)。观察组总有效率高于对照组,不良反应发生率低于对照组,差异有统计学意义(P0.05)。结论采用经纵裂入路显微切除术治疗鞍结节脑膜瘤,可有效改善GCS评分,提高总有效率,且不良反应发生率低。     

鞍结节脑膜瘤显微外科手术32例临床分析

目的 报道鞍结节脑膜瘤显微外科手术治疗的临床疗效.方法 回顾性分析显微手术治疗鞍结节脑膜瘤32例的临床和随访资料,对鞍结节脑膜瘤的显微外科手术技巧和视神经功能保护方法进行探讨.结果 鞍结节脑膜瘤显微手术32例,肿瘤全切除31例,其中包括Simpson Ⅰ级全切除20例,SimpsonⅡ级全切除11例,肿瘤次全切除1例.手术后视力改善10例,视力无变化15例,视力变差7例.全切除的病例术后随访14～62个月,未见肿瘤复发.结论 应用显微外科手术全切除鞍结节脑膜瘤,保护视神经功能和严密的颅底重建,能够取得较好的临床疗效.     

神经内镜辅助眶上锁孔入路切除鞍结节脑膜瘤

目的总结内镜辅助下经眶上锁孔入路显微手术切除鞍结节脑膜瘤的手术效果。方法13例鞍结节脑膜瘤采用眶上锁孔入路,先在显微镜直视下切除部分肿瘤,再在内镜辅助下切除残余肿瘤。结果肿瘤全切除12例（SimpsonⅠ级切除2例,Ⅱ级切除10例）,次全切除1例（SimpsonⅢ级切除）。11例术后随访3个月～6年,平均2.3年,〈1年恢复正常工作和生活9例,术后2年肿瘤复发1例,1年后恢复生活自理1例。结论内镜辅助下眶上锁孔入路切除鞍结节脑膜瘤克服了显微镜直视下的盲区,并发症少,创伤小,效果满意。     

累及鞍区不同部位之脑膜瘤经颅手术入路的选择与评价

目的：探讨累及鞍区不同部位之脑膜瘤手术入路的选择。方法：以四级分类法评价经颅不同手术入路切除累及鞍区不同部位的脑膜瘤４３例所获显露程度。结果：经眶颧额颞下入路对鞍旁脑膜瘤显露最佳；经额鼻眶入路对鞍上脑膜瘤显露最佳，其次为经翼点入路。结论：鞍旁脑膜瘤首选经眶颧额颞下入路；鞍上脑膜瘤大型者首选经额鼻眶入路，中小型者可首选经翼点入路；向一侧桥小脑角发展的鞍后脑膜瘤可选用枕下入路。     

鞍结节脑膜瘤的显微外科手术治疗

目的探讨和评价鞍结节脑膜瘤的临床和影像学特点,以及显微外科技术和手术效果.方法回顾性分析本院1985年至2002年手术治疗的鞍结节脑膜瘤41例,分析其临床和影像学表现的特点.根据CT和MR的表现,将其分为大、中、小3型,采用4种不同的手术入路,比较全切除率、手术结果和并发症发生情况.结果鞍结节脑膜瘤的临床特点是早期出现单侧和双侧视力下降,视野改变不典型.MRI特点为明亮均一的增强,肿瘤中心在鞍上,伴基底硬膜尾征,蝶鞍不扩大.肿瘤的全切除率与肿瘤大小有关,中、小型肿瘤全切除率较高.眶上匙孔入路、翼点入路和眶颧入路显露满意和手术效果好,明显优于单侧额下入路.结论鞍结节脑膜瘤早期出现视力下降,以中、小型肿瘤为主.大多数鞍结节脑膜瘤可以完全及安全地切除,小、中型肿瘤宜采用眶上匙孔入路,中、大型肿瘤宜采用翼点侧裂入路,大型肿瘤宜采用眶颧入路切除肿瘤.     

经蝶窦入路显微手术治疗鞍内非垂体瘤病变23例

目的总结23例鞍内非垂体瘤病变经蝶手术治疗的临床经验。方法23例鞍内非垂体瘤病变：Rathke囊肿7例，垂体脓肿5例，颅咽管瘤3例，脑膜瘤2例，垂体结核性肉芽肿2例，空蝶鞍2例，脊索瘤2例。全部采用经唇下-鼻-蝶窦入路，C-臂机透视监测下，手术显微镜放大10～15倍行显微手术治疗。结果病灶全切除14例，大部切除7例，部分切除2例。术后患者视力及视野明显及部分好转13例，女性患者月经紊乱及男性患者性功能障碍在术后均有不同程度好转。术后无严重并发症，无手术死亡者。结论经蝶入路显微手术治疗鞍区肿瘤是安全和有效的。     

Endoscopic endonasal extended transsphenoidal removal of tuberculum sellae meningioma (TSM): an experience of six cases

Abstract Aims. Tuberculum sellae meningiomas (TSMs) are usually removed through a transcranial approach. Recently, the sublabial transsphenoidal microscopic approach has been used to remove such tumours. More recently, endonasal extended transsphenoidal approach is getting popular for removal of tuberculum sellae meningioma. Here, we describe our initial experience of endonasal extended transsphenoidal approach for removal of suprasellar meningiomas in six consecutive cases. Materials and method. Six patients (four female and two male) who presented for headache and visual loss were investigated with MRI of brain that showed tuberculum sellae meningioma compressing visual apparatus. Average size was 3 × 3 cm in three cases and 4 × 4 cm in rest of the three. All patients underwent endoscopic endonasal extended transsphenoidal tumour removal, but in two patients with large tumour, microscopic assistance was needed. Complete tumour removal was done in all cases except one case where perforators seemed to be encased by the tumour and resulted in incomplete removal. The surgical dural and bony defects were repaired in all patients with thigh fat graft. Nasal packing was not used, but inflated balloon of Foley's catheter was used to keep fat in position. Result. There was mild postoperative cerebrospinal fluid (CSF) leakage in one patient on the fourth postoperative day after removal of lumbar CSF drain and stopped spontaneously on the seventh postoperative day. There were no postoperative CSF leaks or meningitis in the rest of the cases. In one patient, there was visual deterioration due to pressure on optic nerve by grafted fat and improved within 4 weeks. At 4 months after surgery, three patients had normal vision, two patients improved vision comparing with that of preoperative state but with some persisting deficit; one patient had static vision, no new endocrinopathy and no residual tumour on MRI in five cases but residual tumour in remaining case was static at the end of the ninth month. Conclusion. The endoscopic endonasal extended transsphenoidal approach appears to be an effective minimally invasive method for removing relatively small to medium tuberculum sellae meningiomas. With more experience of the surgeon, larger tuberculum sellae meningioma may be removed by purely endoscopic techniques in near future.     

The importance of early diagnosis and treatment of the meningiomas of the planum sphenoidale and tuberculum sellae: a retrospective study of 105 cases

Delay in the diagnosis of meningiomas of the tuberculum sellae and planum sphenoidale is detrimental to the patient in terms of visual recovery, morbidity and mortality. Early accurate diagnosis of these tumors is possible through the use of computed tomography which is recommended for all patients with unexplained impairment of vision. In this article 105 cases of meningiomas of the planum sphenoidale and tuberculum sellae are reviewed. In only five cases was the diagnosis made within three months of the onset of the symptoms.     

Outcome determinants of pterional surgery for tuberculum sellae meningiomas

Summary Background. Current literature on tuberculum sellae meningiomas is very heterogenous due to wide variation in nomenclature, diagnostic and operative techniques. The aim of this study is specifically to analyze the results of pterional craniotomy for tuberculum sellae meningiomas. A homogenous cohort of 42 consecutively operated tuberculum sellae meningioma cases are reviewed with special emphasis on the effects of pterional microsurgery on visual outcome. Methods. This is a retrospective clinical analysis. 42 consecutive patients operated upon during the period of 15 years in a single institution using standard imaging protocols and pterional microsurgery are presented and effect of various variables on visual outcome analysed. Findings. 81% of the patients presented with visual symptoms. The mean duration of symptoms was 12 months. Tumour volumes ranged from 7.5 to 210 mm³. A right sided pterional microsurgery was used in all patients. Complete resection rate was 81%. Vision improved in 58%, worsened in 14%. Non-visual morbidity was 7.1% and mortality was 2.4%. The follow up period of patients ranged from 3 to 192 months (median: 30 months). The mean was 37.5 months (SD = ±36.7 months) and a recurrence rate of 2.4% was observed. Conclusions. A standard pterional craniotomy using microsurgical technique provides the necessary exposure enabling total removal while keeping the complications to a minimum. Upon analysis of our findings we found that patient age of more than 60, duration of visual symptoms longer than 1 year, severe visual symptomatology, predominantly vertical growth, presence of significant peri-tumoural oedema, absence of an intact arachnoid plane and subtotal removal were correlated with a dismal visual outcome.     

Magnetic resonance imaging of tuberculum sellae meningiomas: preventing preoperative misdiagnosis as pituitary macroadenoma.

Despite recent advances in neurodiagnostic imaging, it may be difficult to differentiate tuberculum sellae meningiomas from pituitary macroadenomas preoperatively. Magnetic resonance (MR) imaging has supplanted computed tomography as the imaging modality of choice for sellar and parasellar lesions, but unenhanced MR imaging does not reliably distinguish between all tuberculum sellae meningiomas and pituitary macroadenomas. Accurate differentiation between these alternative diagnoses of a suprasellar mass is important because a tuberculum sellae meningioma always requires a craniotomy, whereas a transsphenoidal route is preferred for removing most pituitary macroadenomas. The gadolinium-enhanced MR images of seven patients with tuberculum sellae meningioma and seven with pituitary macroadenoma were reviewed retrospectively. Although no specific radiological feature was pathognomonic, a combination of several features allowed the correct diagnosis in all cases. Three characteristics of tuberculum sellae meningiomas distinguish them from pituitary macroadenomas: 1) bright homogeneous enhancement with gadolinium, as opposed to heterogeneous, relatively poor enhancement; 2) a suprasellar rather than a sellar epicenter of tumor; and 3) tapered extension of an intracranial dural base. Each of these findings can be subtle, but careful examination of gadolinium-enhanced, high-quality, thin section coronal and sagittal MR images of the parasellar region for this constellation of findings will allow the correct preoperative diagnosis in patients with either of these tumors.     

Exclusive endoscopic removal of a planum sphenoidale meningioma: a case report.

Midline suprasellar meningiomas have traditionally been removed through transcranial approaches. Endoscopic endonasal approaches have already been described for the removal of tuberculum sellae meningiomas (Cook), but their exclusive use for planum sphenoidale meningiomas has never been reported. A case report of a planum sphenoidale meningioma removed through a transnasal endoscopic approach is presented: the goal of this technique is tumor control with minimal morbidity. The anterior skull base defect has been reconstructed with a pedicled mucosa flap from nasal septum (Hadad-Bassagasteguy flap). The postoperative course was uneventful, and no sign of recurrence was noticed at the MRI control performed after 3 months.