蝶眶脑膜瘤18例手术治疗临床分析

目的 探讨经颅入路显微切除蝶眶脑膜瘤的手术方法、疗效及随访结果.方法 对18例蝶眶脑膜瘤患者选用额颞入路、眶颧入路或眶颧结合扩大前颅窝底入路硬膜外结合硬膜内切除肿瘤,在硬膜外磨除增生的蝶骨大翼骨质、眶上裂、视神经管开放减压,其中经额颞入路15例,眶颧入路2例,眶额结合扩大前颅窝底入路1例,术前、术后均有视觉功能评价、手术录像及术后影像评估肿瘤切除程度.结果 肿瘤切除程度:Simpson Ⅰ级2例,SimpsonⅡ级6例,SimpsonⅢ级8例,SimpsonⅣ级2例.18例患者术后突眼情况均有好转,视觉功能改善13例.随访6 -56个月(平均25.3个月),2例患者肿瘤复发.结论 选择合适的手术入路显微切除蝶眶脑膜瘤,可获得充分显露和眶尖、球后减压,可有效缓解突眼、视觉障碍及眼肌麻痹.因肿瘤多累及眶尖、眶上裂、海绵窦等重要结构,肿瘤难以全切,术后容易复发.     

颅眶沟通脑膜瘤的显微外科治疗

目的 探讨颅眶沟通脑膜瘤的临床特点及显微手术疗效。方法 回顾性分析3例颅眶沟通脑膜瘤患者的临床资料,多有病例均接受显微手术肿瘤切除,其中额颞眶颧入路2例,眶额颧入路1例结果2例肿瘤全切,1例肿瘤近全切除。术后患者眼球突出均明显改善;患者视力改善2例,视力较术前无明显改善1例。术后未见脑脊液漏,颅内感染等严重并发症。术后随访4~10个月,平均6个月,未见肿瘤复发。结论 显微外科手术切除颅眶沟通脑膜瘤可显著缓解患者症状,术后恢复快,并发症少,是一种安全有效的手术方式。     

颅眶沟通脑膜瘤的显微外科治疗

目的探讨颅眶沟通脑膜瘤的临床特点及显微手术疗效。方法回顾性分析3例颅眶沟通脑膜瘤患者的临床资料,多有病例均接受显微手术肿瘤切除,其中额颞眶颧入路2例,眶额颧入路1例结果 2例肿瘤全切,1例肿瘤近全切除。术后患者眼球突出均明显改善;患者视力改善2例,视力较术前无明显改善1例。术后未见脑脊液漏,颅内感染等严重并发症。术后随访4～10个月,平均6个月,未见肿瘤复发。结论显微外科手术切除颅眶沟通脑膜瘤可显著缓解患者症状,术后恢复快,并发症少,是一种安全有效的手术方式。     

额颞眶颧入路切除颅中窝底肿瘤

目的 探讨额颞眶颧入路的特点及其切除颅中窝底肿瘤的手术技巧和适应证。方法 本入路是将额颞开颅颅骨切除的范围扩大到包括眶上缘、眶外测壁及颧弓,以增加肿瘤的暴露,有利于肿瘤的切除。采用该方法对２２例颅中窝底肿瘤进行手术,取得良好效果。其中脑膜瘤９例,垂体瘤８例,神经鞘瘤２例,脊索瘤２例海绵状血管瘤１例。结果 获得肿瘤全切除１３例,次全切除６例,大部分切除３例,无手术死亡和严重手术并发症结论 初步手术     

蝶-眶脑膜瘤的手术治疗

目的探讨蝶眶脑膜瘤的手术方法.方法回顾性地分析了10例蝶眶脑膜瘤患者的临床表现、影象学资料、手术方法及手术效果.结果男性3例,女性7例,最小39岁,最大55岁,平均46.7岁,肿瘤直径3～6 cm,所有患者均用眶额颞去颧弓入路:8例全切,1例次全切,1例大部切除,术后1例出现短暂的对侧肢体力弱,1例眼球运动障碍.结论用现代颅底外科技术结合术前部分供血血管栓塞可满意地切除该型肿瘤.     

前中颅底沟通瘤的手术入路和显微切除

目的 探讨前中颅底沟通瘤的手术入路和颅底重建的方法。方法 采用经额鼻筛眶入路、经额颞眶颧入路和经额颞联合耳前颞下入路暴露肿瘤，予以显微手术切除。结果 27例该部位肿瘤施行显微手术治疗，肿瘤全切除2l例。次全切除3例，大部分切除3例。手术结果良好，无手术死亡及严重并发症。结论 前中颅底内外沟通瘤应根据肿瘤位置、侵犯范围选择适当手术入路，充分暴露病灶，有利于广泛切除肿瘤。颅底重建是避免脑脊液漏及颅内感染的关键。     

前颅底及颅鼻眶沟通脑膜瘤切除及颅底重建探讨

目的探讨显微手术切除前颅底脑膜瘤的手术入路选择以及颅底重建的适应证。方法经头颅CT或MRI扫描确诊,据肿瘤大小、部位选择不同的入路,显微镜下切除肿瘤并行颅底修复重建。本组颅底脑膜瘤110例,经额颞眶颧联合入路切除35例,经额鼻筛眶入路38例,经翼点入路切除4例,经冠状开颅切除33例。结果镜下全切除肿瘤88例,次全切除17例,大部分切除5例。临床痊愈85例,好转23例,死亡2例。随访79例,肿瘤复发5例,行第二次手术切除,死亡5例,余恢复良好。结论根据肿瘤的大小、部位选择不同的手术入路,显微镜下切除前颅底脑膜瘤及必要时颅底修复重建是一种安全、有效的治疗方法。     

颅眶沟通性病变临床特点及显微神经外科手术治疗

目的探讨颅眶沟通性病变的临床特点和显微外科手术疗效。方法回顾性分析48例颅眶沟通性病变的临床资料,均行显微手术切除,经眶额入路16例,翼点入路21例,扩大翼点入路6例,额颞眶颧入路5例。结果病变全切除36例,次全切除6例,部分切除6例。术后发生硬膜下积液1例,颅内感染2例,经治疗后痊愈;无颅内出血及脑脊液漏等并发症发生。随访2～31个月,平均14.5个月;无肿瘤复发或进展47例,死亡1例。多数病人术前症状好转。术后新发视力、视野障碍3例,眼球活动障碍或复视8例。结论颅眶沟通性病变良性肿瘤居多,以脑膜瘤最常见;显微手术切除为首选治疗方法,全切除率高,术后并发症少,且症状改善率高。     

颅眶沟通性肿瘤显微手术探讨

目的讨论颅眶沟通性肿瘤的特点及手术治疗方法。方法35例颅眶沟通性肿瘤病人中,采用额下硬膜外入路手术切除4例,额颞眶颧入路2例,眶上-翼点入路10例,改良翼点入路17例,翼点和颞下联合入路2例。先切除颅内肿瘤,再开眶切除眶内肿瘤。结果肿瘤全切29例,次全切4例,部分切除2例,肿瘤全切率为82.9%（29/35）。结论对于颅眶沟通性肿瘤,充分的术前准备,正确的手术入路选择,细致的术中操作,耐心的颅底重建以及多科的协调合作,是手术成功的重要保证。     

前颅窝底脑膜瘤手术入路的选择与评价

目的：探讨和评价切除前颅窝底脑膜瘤的最佳手术入路,方法：回顾性分析我科手术治疗的前颅窝底脑膜瘤68例,将其分为前部和后部二组,大,中,小三型,采用5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：肿瘤的全切除率与肿瘤大小和部位有关。中,小型肿瘤和前部肿瘤的全切除率较高,翼点入路和眶颧入路明显优于双侧或单侧额下入路,全切除率高,术后并发症少和手术效果好,结论：前颅窝底前部脑膜瘤宜采用眶颧侧裂入路,后部脑膜瘤宜采用翼点侧裂入路切除肿瘤,双侧额下入路应尽量少用。     

手术切除前颅底及蝶骨嵴脑膜瘤33例临床体会

目的 探讨前颅底及蝶骨嵴脑膜瘤的手术切除方法 和技巧. 方法 回顾性分析安徽医科大学附属安庆医院神经外科自1998年7月至2008年4月收治的33例前颅底及蝶骨嵴脑膜瘤患者的临床资料,其中手术采用经单侧额下入路4例,双侧额下入路17例,翼点入路5例,改良翼点入路7例. 结果 术中肿瘤全切除30例,次全切除2例,大部分切除1例.术后症状改善28例,但出现偏瘫失语1例,精神症状1例,死亡1例,复发2例. 结论 术前通过影像学检查评估肿瘤的位置及与颅底、血管、神经的关系来选择不同的手术入路,术中精细操作以加强对血管、神经的保护是提高肿瘤全切除率,降低致残率、死亡率和复发率的关键.     

Bilateral sphenoorbital hyperostotic meningiomas with proptosis and visual impairment: a therapeutic challenge. Report of three patients and review of the literature

Objective

Bilateral hyperostotic sphenoorbital meningiomas are extremely uncommon. Due to extensive infiltration of the orbits and the frontotemporal skull base, often only a subtotal tumor resection is feasible. Thus far, no treatment algorithms have been suggested for this rare tumor entity. We report on the surgical management of 3 patients.

Methods

All 3 patients underwent a pterional approach for surgical resection. Surgery was performed in two stages, primarily treating the most affected side. Treatment consisted of microsurgical resection of the infiltrated sphenoid wing and orbital walls, intraorbital tumor removal and optic nerve decompression. Orbital wall reconstruction was performed using titanium mesh allografts. Radiation therapy was administered in 1 patient with residual tumor infiltration of the cavernous sinus.

Results

Our series includes 2 women (51 and 68 years old) suffering from simultaneous progressive bilateral loss of vision and proptosis and 1 woman (69 years old) who developed contralateral disease after surgical resection of a hyperostotic sphenoorbital meningioma 16 years earlier. After optic nerve decompression, vision improved in 2 cases after surgery. Initial visual deterioration was observed in 1 case but improved on longterm follow-up. The degree of proptosis was reduced in all treated eyes.

Conclusion

In bilateral hyperostotic sphenoorbital meningiomas we propose staged surgery when clinical and radiological progression is observed. Subtotal tumor resection with the aim of optic nerve decompression and subsequent orbital reconstruction provides satisfactory results. The most affected eye should be treated first. In case of additional cavernous sinus infiltration, focal radiation therapy can be considered.     

大型及巨大型岩斜区脑膜瘤的显微外科治疗

目的 总结大型及巨大型岩斜区脑膜瘤的治疗经验.方法 根据临床表现和影像学特征,将41例大型及巨大型岩斜区脑膜瘤分为3组:Ⅰ组(肿瘤位于上斜坡,18例)、Ⅱ组(肿瘤位于中下斜坡,17例)、Ⅲ组(肿瘤累及全斜坡,6例).Ⅰ组肿瘤采用颞枕下经小脑幕入路,Ⅱ组肿瘤采用枕下乙状窦后入路,Ⅲ组肿瘤采用幕上下联合入路切除岩斜区脑膜瘤.结果 肿瘤切除Simpson Ⅰ～Ⅱ级Ⅰ组7例,Ⅱ组7例;Ⅲ级切除Ⅰ组8例,Ⅱ组8例,Ⅲ组2例;Ⅳ级切除Ⅰ组3例,Ⅱ组2例,Ⅲ组2例.Ⅲ组病人死亡2例.结论 对于不同类型的大型及巨大型岩斜区脑膜瘤,选择不同的手术方式,对提高术后疗效和减少手术并发症有重要作用.     

Sphenoorbital meningiomas: surgical management and outcome

Abstract

Objective:

Surgical management of sphenoorbital meningiomas ranges among the most complex of intracranial tumors. We report on our experience of surgical technique, outcome, and tumor recurrence in sphenoorbital meningiomas.

Methods:

Between 2003 and 2013, surgical resections for sphenoorbital meningioma were performed in 18 patients (aged 49·6±9·8 years, only women), with two patients operated anew due to tumor recurrence.

Results:

Main symptom was proptosis (83·3%), followed by diminished visual acuity (38·9%), and dizziness (11·1%). In all patients the lateral orbital wall was resected, whereas the orbital roof and the zygoma were removed according to the extent of their tumorous infiltration. Unroofing of the optic canal was performed in 10 cases (55·6%) and unroofing of the optic foramen in two (11·1%). For reconstruction split calvarian bone and titanium mesh were used in six (33·3%) and seven patients (38·9%), respectively; in one patient both techniques were applied. In five patients (27·8%), no reconstruction was necessary.

Complete tumor resection (Simpson grade 1 and 2) was achieved in 14 cases (77·7%). Postoperatively, proptosis improved in all patients. Median follow-up was 39·5±33·3 months (range 1–105) in 16 patients; 2 patients were lost to follow-up. No tumor recurrence was noted in five (27·8%) patients, whereas in nine (50%) patients tumor remnants proved stable over time. Two (11·1%) patients experienced progression of residual tumor, resulting in reoperation after 27 and 109 months, respectively.

Discussion:

Despite their delicate anatomical relations, surgery of sphenoorbital meningiomas is safe when combining modern techniques.     

小骨窗经前纵裂入路切除鞍上脑膜瘤29例

目的探讨鞍上脑膜瘤经前纵裂入路切除的价值及效果。方法 29例经MRI检查及术后病理检查确诊为鞍上脑膜瘤患者,瘤体最大直径3～6 cm,采用小骨窗(约4 cm×5 cm)经前纵裂入路显微手术切除。结果肿瘤全切除25例(86%)(SimpsonⅠ、Ⅱ),次全切除4例。视力视野改善者19例。术后尿崩症2例,电解质紊乱1例,无手术死亡。结论鞍区脑膜瘤向前方、上方、鞍内生长者,采用小骨窗经前纵裂入路能较好显露瘤体,脑组织牵拉轻,并发症发生率低,显著提高肿瘤的全切除率。     

经额外侧入路手术治疗鞍区中线病变

目的探讨经额外侧入路手术治疗鞍区中线病变的临床疗效。方法1999年10月～2003年4月经额外侧入路施行显微外科手术治疗鞍区中线部位病变患者128例,其中垂体腺瘤57例、颅咽管瘤34例、鞍结节和蝶骨平台脑膜瘤15例、前床突脑膜瘤6例、拉克囊肿4例以及其它病变12例。结果128例患者手术后恢复良好,未发生颅内感染,无严重神经功能障碍,无一例死亡。肿瘤全切除者中垂体腺瘤52例(91.2%)、颅咽管瘤30例(88.2%)、鞍结节和蝶骨平台脑膜瘤15例(100%)、前床突脑膜瘤6例(100%)、拉克囊肿4例(100%),前交通动脉动脉瘤3例夹闭顺利。手术所用时间比常规翼点入路缩短20～30min。结论额外侧入路显露鞍区中线部位病变的效果与翼点入路并无差别。     

岩斜区脑膜瘤的显微手术入路选择和手术技巧 （附23例报道）

目的 探讨岩斜区脑膜瘤的手术入路选择及手术疗效。方法 回顾性分析2014年11月至2015年11月手术治疗的23例岩斜区脑膜瘤的临床资料，其中颞下经天幕入路15例，枕下乙状窦后入路8例。结果 肿瘤全切除17例，部分切除6例。术后发生肺部感染1例、动眼神经麻痹和面瘫3例、颞叶水肿伴出血2例。术后随访6~18个月，中位数13个月；全切肿瘤无复发，残余肿瘤无进展；末次随访KPS评分较术前明显提高（P<0.05）。结论 岩斜区脑膜瘤应制定个体化的、以手术为中心结合放化疗的综合治疗方案，以病人的生存质量为导向，将提高病人的生存率的同时保证生活质量为最终目标。     

耳前颞下经岩骨经小脑幕硬膜下入路切除岩斜区脑膜瘤

目的探讨耳前颞下经岩骨经小脑幕硬膜下入路切除岩斜区脑膜瘤的手术方法及其治疗效果。方法回顾性分析40例岩斜区脑膜瘤病人的临床资料,采用耳前颞下经岩骨经小脑幕硬膜下入路显微外科手术切除肿瘤。结果肿瘤全切除28例（70.0%）,近全切除10例（25.0%）,大部分切除2例（5.0%）。40例病人随访3~15个月,术后6例发生动眼神经麻痹,均在3个月内完全恢复;10例展神经麻痹病人中,完全恢复4例,不同程度恢复4例,未恢复2例;8例轻度面瘫病人中,完全恢复6例,未恢复2例;12例面部麻木加重病人中,术后恢复至术前水平6例,较术前加重6例;偏瘫2例和失语3例,6个月内恢复至术前水平。无脑脊液漏和手术死亡病例。结论耳前颞下经岩骨经小脑幕硬膜下入路能够充分显露并切除肿瘤基底位于中、上斜坡的岩斜区脑膜瘤,术后脑神经功能障碍、肢体偏瘫、脑脊液漏的发生率低。     

镰幕交界处脑膜瘤

目的探讨镰幕交界处脑膜瘤的诊断及手术入路选择。方法回顾性分析9例镰幕交界处脑膜瘤病人的临床资料。本组症状均以头痛、眩晕为主。手术选择枕经天幕入路8例,幕下小脑上入路1例。结果本组肿瘤均获SimpsonⅠ或Ⅱ级切除。无手术死亡。术后出现皮质盲3例,1～3个月后恢复。随访6～44个月,平均21个月;复发1例,行2次手术。结论镰幕交界处脑膜瘤的手术入路需根据肿瘤起源及扩展方向进行选择;术中需注意保护直窦和Galen静脉系统。     

经翼点-眶顶入路切除颅眶沟通肿瘤

目的 探讨经翼点-眶顶入路切除颅眶沟通肿瘤的手术方法和治疗效果.方法 回顾性分析自2004年至2009年收治的13例颅眶沟通肿瘤患者的临床资料,采取经翼点-眶顶入路的手术方式切除肿瘤.结果 在13例患者中,肿瘤全切10例,大部或部分切除3例.经组织病理学检查证实良性肿瘤9例,恶性肿瘤4例.最常见的肿瘤类型为脑膜瘤,本组6例.所有患者的临床症状在术后均有不同程度的改善,无手术死亡及严重并发症.结论 经翼点-眶顶入路切除颅眶沟通肿瘤,操作简便、易于暴露、手术创伤小.术中应注意保护球后重要组织,并根据需要进行眶顶修补或重建.

Abstract：

Objective To investigate the procedure via pterional -orbital approach for cranioorbital communicating tumors.Method 13 patients with cranio -orbital communicating tumors were retrospectively analyzed.Pterional approach was adopted for the operations with resection of orbital roof, and the surgical advantages and cautions were concerned.Results In 13 patients, 10 cases undertook total removal, and 3 cases undertook subtotal or partial removal of tumors.9 cases were benign, and 4 cases were malignant tumors.Pathological results showed that 6 cases were meningioma which was the most common type.Patient's follow - up ranged from 3 to 52 months, which showed that no operative death and severe complications were revealed.The most common complication was injury of extraocular muscles, which occurred in 4 patients.Conclusions Resection of cranio - orbital tumors via pterional - orbital approach provided facilities for exposing tumors and showed less operative damages.Protecting important tissues in postglobal region and reconstructing orbital roof will result in less postoperative complications.