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经翼点入路显微手术治疗蝶骨嵴脑膜瘤 总被引:1,自引:0,他引:1
采用经翼点入路显微手术治疗48例蝶骨嵴脑膜瘤,(根据所见肿瘤主体部位分为外侧型和内侧型)。外侧型25例行手术全切除,内侧型23例中全切除16例,次全切除5例,大部分切除2例,术后5例视觉障碍明显改善,1例单侧视力损害加重,动眼神经损伤1例,偏瘫1例,死亡1例。术后26例随访2个月~9a,复发6例均为次全切或大部分切除患者。认为经翼点入路手术可获良好显露,充分利用显微技术辨别肿瘤与周围血管、神经的关系,注意保护穿通动脉,酌情处理肿瘤与重要结构的黏连,是手术成功的关键。 相似文献
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目的探讨经颞下-小脑幕入路显微手术切除岩斜区肿瘤的疗效。方法回顾性总结采用经颞下-小脑幕入路显微手术切除的12例岩斜区肿瘤病例的临床资料。结果12例包括脑膜瘤7例、神经鞘瘤3例、胆脂瘤2例。肿瘤全切除8例,次全切除2例,大部切除2例。术后发生近期记忆障碍1例,肢体偏瘫1例,感觉性失语1例,治疗随访3个月后均痊愈。结论经颞下-小脑幕入路是切除岩斜区肿瘤的极佳入路,损伤小,并发症少,值得推广应用。 相似文献
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经纵裂胼胝体前入路显微全切除鞍膈脑膜瘤(附13例报告) 总被引:1,自引:0,他引:1
目的 提高鞍膈脑膜瘤手术全切除率,减少术后复发,有效治疗和预防术后并发症,降低病死率。方法 对13例患者采用改良手术入路,扩大病变部位的暴露范围,减少术中因牵拉所造成的脑损害,利用显微外科技术在分块切除肿瘤的同时.有效保护与病变关系密切的血管、神经、丘脑下部、垂体、垂体柄等重要结构。结果 13例均一次全切除肿瘤,随访1~8年,无肿瘤复发,除1例术前视力已完全丧失外.3例生活自理。9例均恢复正常。结论 经纵裂胼胝体前切除鞍膈脑膜瘤是较理想的手术入路,可一次全切除肿瘤,并能有效保护肿瘤周围的重要结构。微侵袭显微外科技术是其必备条件。 相似文献
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近年来 ,我们采用翼点入路、眶额入路、额颞眶颧入路并应用显微技术切除 13例颅眶沟通肿瘤 ,手术效果满意。现报告如下。临床资料 :共收治 13例 ,男 8例 ,女 5例 ;年龄 17~ 6 5岁。病理诊断脑膜瘤 7例 ,横纹肌肉瘤、恶性淋巴瘤各 2例 ,视神经胶质瘤、转移瘤各 1例。眼球突出 12例 ,视力下降 7例 ,眼球活动障碍 4例 ,复视 5例。 CT扫描 13例 ,MRI检查 8例 ,DSA9例。肿瘤全切 12例 ,次全切 1例。手术方法 :采用翼点入路、眶额入路、额颞眶颧入路开颅 ,采取以下 4种方法开眶 :1扩大眶顶骨缺损开眶 :暴露肿瘤后 ,沿肿瘤周边放射状切开肿瘤… 相似文献
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目的探讨经胼胝体-透明隔-穹窿间入路显微手术方法切除第三脑室和松果体区肿瘤并行终板造瘘术的疗效,讨论显微解剖学的理论基础。方法对经胼胝体-透明隔-穹窿间入路显微手术切除第三脑室和松果体区肿瘤并行终板造瘘术29例患者的临床资料进行回顾分析。结果 29例在手术显微镜下行肿瘤全切除13例,次全切除7例,部分切除9例。均在处理完肿瘤后行终板造瘘术。结论经胼胝体-透明隔-穹窿间入路手术切除第三脑室和松果体区肿瘤系通过胚胎组织残留的透明隔间隙进入第三脑室,正常组织损伤极少,可在直视操作下切除第三脑室及松果体区肿瘤,肿瘤全切除或次全切除率高,对于未做肿瘤全切除及考虑术后局部组织肿胀或放疗期间局部肿胀致导水管开口梗阻者,可同时行终板造瘘术,以解决脑积水问题。 相似文献
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目的探讨枕下后正中入路治疗枕骨大孔区肿瘤的临床疗效。
方法回顾性分析广东三九脑科医院神经外一科自2012年1月至2019年1月收治的16例采用后正中入路显微外科结合超声吸引切除的枕骨大孔区肿瘤患者的临床资料,其中神经鞘瘤5例,脑膜瘤7例,血管母细胞瘤4例,观察16例患者的术后疗效。
结果16例患者中肿瘤全切除14例,次全切除2例。术后出现后组颅神经损伤加重者2例,无手术死亡。随访3个月~7年,除1例术后仍有肢体乏力、行走不稳外,其余患者症状消失。1例次全切除患者术后3年复发。
结论枕骨大孔区肿瘤显微手术技巧要求高,脑干、后组颅神经和血管保护十分重要,枕下后正中入路可以广泛地应用于枕骨大孔区肿瘤的手术治疗。 相似文献
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Tetsuo Tamura Yusuke Kawamura Kenji Ikeda Yuya Seko Taito Fukushima Hiromitu Kumada Shozo Yamada Yuji Matumaru 《Clinical journal of gastroenterology》2013,6(4):319-325
We report on two cases of hepatocellular carcinoma (HCC) with metastasis to the cavernous sinus and sphenoid sinus. Both cases presented with diplopia and retro-orbital headache and both underwent surgery for a primary pituitary gland tumor. After surgery, both cases were diagnosed with metastases from HCC. Case 1 was a 67-year-old male with a history of HCC who was referred to our hospital for pituitary tumor surgery. The tumor appeared to be in the sella turcica and to invade the sphenoid sinus and right cavernous sinus. Transnasal transsphenoidal surgery (TSS) was performed. The tumor was postoperatively diagnosed by histology to be a metastatic pituitary tumor from HCC. Radiotherapy was administered to the metastatic site. Case 2 was a 58-year-old male with a history of TSS for a pituitary tumor 16 years previously. He was referred to our hospital for TSS for a recurrent pituitary adenoma. TSS was performed twice in 3 months. During a preoperative general examination, HCC and chronic hepatitis B were revealed. TSS was performed initially, followed by arterial infusion chemotherapy. After TSS, the pituitary tumor was diagnosed by histology to be a metastasis from HCC. As with Case 1, radiotherapy was administered to the metastasis. Most tumors in the sella turcica are pituitary adenomas, although some cases of metastatic pituitary tumors and skull base metastases have been reported. Distant metastases generally have a poor prognosis; however, surgery to the metastatic site can effectively control symptoms caused by the metastatic tumor. 相似文献
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Purpose
In this study, we set out to define our institutional criteria for patient eligibility for transsphenoidal resection of parasellar meningiomas, and to report our experience with extended transnasal approaches for these lesions. We aimed to discuss the important considerations of patient selection and risk stratification to optimize outcomes for patients with these difficult lesions, and also include considerations that should be reviewed during surgical approach selection.Methods
Medical records from Brigham and Women’s Hospital were retrospectively reviewed for all patients who underwent transsphenoidal surgery for pituitary disease with the senior author from April 2008 to March 2017 (938 procedures). Patients undergoing surgery for anterior skull base meningioma were identified and patient data were collected.Results
Seven patients (four women, three men) underwent transsphenoidal resection (five endoscopic, one microscopic, and one hybrid endoscopic/microscopic) of pathologically-confirmed anterior skull base meningiomas during the study period. Five patients presented with visual field deficits, three presented with headache, two presented with hypopituitarism, and one woman presented with infertility. The median maximum tumor diameter was 1.7 cm (range 1.4–4.2 cm). Six patients underwent subtotal resection, and one underwent gross total resection. The median MIB-1 index was 2.3 (range 1.0–7.6). Complications included two readmissions (one on POD11 for small bowel obstruction, one on POD48 for epistaxis), and the development of new onset thyroid deficiency and transient diabetes insipidus in one patient. Two patients had reoperations by craniotomy for tumor recurrence after 5 and 6 years, respectively.Conclusions
Although more commonly treated transcranially, anterior skull base meningiomas are sometimes amenable to resection transphenoidally. Patient selection is critical, and multiple factors, including tumor size, consistency, and location, patient and surgeon preference, and presenting symptoms each affect the optimum surgical approach. We have developed criteria for patient selection so that transsphenoidal surgery can be used to resect or debulk anterior skull base meningiomas safely and with favorable outcomes.13.
Christopher S. Graffeo August R. Dietrich Bartosz Grobelny Meng Zhang Judith D. Goldberg John G. Golfinos Richard Lebowitz David Kleinberg Dimitris G. Placantonakis 《Pituitary》2014,17(4):349-356
Endoscopic endonasal surgery has been established as the safest approach to pituitary tumors, yet its role in other common skull base lesions has not been established. To answer this question, we carried out a systematic review of reported series of open and endoscopic endonasal approaches to four major skull base tumors: olfactory groove meningiomas (OGM), tuberculum sellae meningiomas (TSM), craniopharyngiomas (CRA), and clival chordomas (CHO). Data from 162 studies containing 5,701 patients were combined and compared for differences in perioperative mortality, gross total resection (GTR), cerebrospinal fluid (CSF) leak, neurological morbidity, post-operative visual function, post-operative anosmia, post-operative diabetes insipidus (DI), and post-operative obesity/hyperphagia. Weighted average rates for each outcome were calculated using relative study size. Our findings indicate similar rates of GTR and perioperative mortality between open and endoscopic approaches for all tumor types. CSF leak was increased after endoscopic surgery. Visual function symptoms were more likely to improve after endoscopic surgery for TSM, CRA, and CHO. Post-operative DI and obesity/hyperphagia were significantly increased after open resection in CRA. Recurrence rates per 1,000 patient-years of follow-up were higher in endoscopy for OGM, TSM, and CHO. Trends for open and endoscopic surgery suggested modest improvement in all outcomes over time. Our observations suggest that endonasal endoscopy is a safe alternative to craniotomy and may be preferred for certain tumor types. However, endoscopic surgery is associated with higher rates of CSF leak, and possibly increased recurrence rates. Prospective study with long-term follow-up is required to verify these preliminary observations. 相似文献
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目的探讨岩斜区脑膜瘤采用不同手术入路的治疗效果。 方法回顾性分析中山大学附属第一医院神经外科自2013年6月至2020年6月收治的76例岩斜区脑膜瘤患者的临床资料,分析其临床表现、手术效果,同时对不同手术入路的手术效果和并发症进行比较。 结果76例岩斜区脑膜瘤,肿瘤全切除42例(55.3%),次全切除28例(36.8%),部分切除6例(7.9%)。术后病理提示世界卫生组织(WHO)Ⅰ级脑膜瘤71例(93.4%),WHOⅡ级脑膜瘤5例(6.6%)。术后颅神经受损26例,脑干受损2例,脑脊液漏4例,颅内感染5例。术前平均卡氏功能状态(KPS)评分为(73.6±8.7)分,术后6个月平均KPS评分为(79.7±8.8)分,术后6个月平均KPS评分高于术前(P<0.05)。对不同入路而言,颞下组全切率高于乙状窦后组(P<0.05),但术中出血量多于乙状窦后组(P<0.05)。 结论岩斜区脑膜瘤大多为良性肿瘤,且多数岩斜脑膜瘤可以获得全切除或次全切除。颞下入路全切率高,但术中出血多于乙状窦后入路。 相似文献
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目的神经导航测量单鼻腔蝶窦入路垂体腺瘤手术患者鞍区的解剖结构。方法对26例垂体腺瘤患者术前强化CT扫描图像进行三维重建,从不同角度和层面观察蝶窦和蝶鞍的结构;经单鼻腔蝶窦入路手术中,利用Brain LAB Vector Vision神经导航系统对相关解剖结构进行测量。结果经测量,蝶窦前后径为(22.1±6.5)mm、左右径为(17.6±6.1)mm、上下径为(19.0±5.8)mm,两侧海绵窦之间最小距离为(12.7±1.5)mm,两侧颈内动脉之间最小距离为(13.8±1.9)mm,左侧鼻孔中心到蝶窦腹侧壁的最短距离为(72.8±5.9)mm,左侧鼻孔中心到鞍底的最短距离为(82.2±6.3)mm。结论利用神经导航系统可以较准确地测量垂体腺瘤患者鞍区的解剖数据,这些数据对单鼻腔蝶窦入路手术有一定指导作用。 相似文献
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Application of the endoscopic prelacrimal recess approach to the maxillary sinus in unilateral maxillary diseases
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Yi‐Tsen Lin MD Chih‐Feng Lin MD Te‐Huei Yeh MD PhD 《International forum of allergy & rhinology》2018,8(4):530-536
Background
The endoscopic endonasal prelacrimal recess approach to the maxillary sinus provides wide access to the walls and recesses of the maxillary sinus, and its use has been reported in many maxillary sinus and skull base diseases. The objective of this study was to determine the indication and feasibility of endoscopic sinus surgery using the prelacrimal recess approach in unilateral maxillary sinus diseases.Methods
We reviewed 192 cases of unilateral maxillary sinus diseases; over 2 years, 15 cases underwent endoscopic surgery via the prelacrimal recess approach. Data regarding preoperative computed tomography scans, operative findings, postoperative pathological diagnoses, postoperative complications, and disease recurrences were obtained from medical records.Results
Patients who underwent surgery via the prelacrimal recess approach did so mostly because tumors were present in the maxillary sinuses (12/15; 80%), while most of the patients in this study underwent surgery because of chronic inflammation (122/177; 68.9%) and fungal infections (40/177; 22.6%). Among 15 patients undergoing surgery via the prelacrimal recess approach, 9 were cases of inverted papilloma. The mean follow‐up period was 16.5 months (range, 6 to 28 months). No postoperative complications occurred after the prelacrimal recess approach. One out of the 15 cases undergoing the prelacrimal recess approach had tumor recurrenceConclusion
Most chronic inflammation and fungal infections of the unilateral maxillary sinuses can be managed through a middle meatal antrostomy. The endoscopic prelacrimal recess approach is a reliable and effective method used to approach maxillary sinus diseases.17.
前颞叶内侧切除术治疗颞叶内侧型癫痫 总被引:1,自引:0,他引:1
目的探讨前颞叶内侧切除术治疗颞叶内侧型癫痫的治疗效果。方法21例顽固性颞叶癫痫患者,采用无框架神经导航辅助,经颞中回行前颞叶内侧切除术,切除前颞叶、杏仁核及海马。采用分级量表进行针对癫痫发作控制效果的评价。结果21例术后随访6~29个月,神经功能均改善,无严重手术并发症。16例(76%)癫痫发作完全消失(EngelⅠ级),3例(16%)癫痫发作极少(EngelⅡ级),2例(8%)癫痫发作减少(EngelⅢ级)。结论前颞叶内侧切除术是治疗颞叶癫痫的有效方法。神经导航辅助下手术彻底切除杏仁核及海马,避免了语言区和视放射的损伤。 相似文献