鞍旁巨大脑膜瘤的手术治疗

目的探索鞍旁巨大脑膜瘤的手术治疗及其并发症的预防。方法回顾性地分析手术治疗的15例鞍旁巨大脑膜瘤的临床资料。结果11例达到全切除,2例次全切除,2例大部切除。术后第二天7例出现同侧动眼神经麻痹,2例滑车神经和外展神经障碍,2例对侧肢体轻瘫;术后2周2例对侧肢体轻瘫者已恢复,但颅神经障碍者未见明显变化;术后3月随访时,7例动眼神经麻痹者5例已恢复,2例滑车神经和外展神经障碍者1例恢复,术前视力减退者2例明显改进,6例无变化。术后无死亡。结论用现代颅底外科技术大部分鞍旁巨大脑膜瘤可全切。但对于已侵润神经、血管外膜者不要勉强切除,以免神经血管损伤。

Surgical Management of Giant Parasellar Meningiomas

Objective To explore the surgical treatment of giant parasellar meningiomas and prevention of its complications. Method A retrospective analysis of the clinieal data including the rate of total removal of the tumor and the operative complications was performed in 15 consecutive patients with giant paraseller meningiomas who recieved the operation. Results The tumors were totally removed in 11 of the 15 patients, subtotally in 2 and partially in 2. On the 2nd day after the operation, 7 patients developed the oculomotor paralysis, 2 dysfunctions of trochlear and abducents nerves ipsilateral to the tumors, and 2 hemiplegia contralateral to the tumors. Two patients recovered from the hemiplegia and the patients with cranial dysfunctions were unchanged. The following-up 3 months after the operation showed that of 7 patients oculomotor paralysis, 5 recovered and 2 were unchanged. Of 2 patients with dys-function of trochlear and abducens nerves, 1 recorved and 1 unchanged, and of 8 patients with visual impairement before the operation, 2 were improved and 6 unchanged. No case died after the operation. Conclusions Most of giant parasellar tumors can be totally removed by modern technique for skull base surgery. However, a small part of the tumor adhering to ICA and cranial nerves should not be reluctantly removed to avoid damage to the nerves and vessles.