内侧型蝶骨嵴脑膜瘤的显微外科治疗

目的 提高内侧型蝶骨嵴脑膜瘤的全切率,降低病死率和致残率.方法 对25例内侧型蝶骨嵴脑膜瘤显微外科治疗病例的临床资料进行回顾性分析.结果 冠状位计算机体层摄影术有助于判断肿瘤的生长点.磁共振成像可显示肿瘤与海绵窦、颈内动脉的关系.1例肿瘤侵入海绵窦,11例肿瘤包绕颈内动脉和主要分支.肿瘤附着点为前床突和(或)小翼的内侧.18例达Simpson Ⅰ、Ⅱ级全切除.无手术死亡,疗效满意.结论 显微手术可明显提高肿瘤全切率,减少术后并发症,降低病死率.手术要点是尽早离断肿瘤基底并沿颈内动脉床突上段由近向远分离切除包绕的肿瘤.由于多数存在肿瘤与血管之间的蛛网膜界面,提倡在第1次手术中采用积极的显微外科治疗.

Microsurgical Treatment of Medial Sphenoid Ridge Meningiomas

Objective To improve the total removal rate and to reduce the mortality and morbidity of medial sphenoid ridge meningiomas.Methods The clinical data of 25 cases with medial sphenoid ridge meningiomas were analysed retrospectively.Results Coronal CT was particularly helpful in identifying the origin of the lesions.The relationships between tumor and cavernous sinus,arteries(ICA,MCA,ACA) were well demonstrated on MRI.Cavernous sinus infiltration was found in one case,cavenous sinus compression in one,partial or entire vessel encasement in 11.Durali attachments of the tumors were at anterior clinoid or/and inner portion of the lesser wing.Total removal of the tumor of Simpson's 1 to 2 grade was achieved in 18 cases.No postoperative mortality was found.The surgical effects were satisfactory in all the patients.Conclusion Microsurgery can greatly heighten the total resection rate of tumors,and reduce the postoperative complications and mortality.For surgical skills we suggest that the dural attachment of the lesion should be dissected along the sphenoid wing first,in order to minimize blood loss and to facilitate the orientating and exposing of the supraclinoidal segment of ICA,and then the engulfing tumor is dissected proximally to distally.Because of the presence of interfacing arachnoid membrane in most of the cases,we advocate to remove the tumor with a vigorous attempt in the initial operation.