桥小脑角大型脑膜瘤的显微手术治疗

目的探讨桥小脑角大型及巨大型脑膜瘤手术入路及显微手术切除方法方法回顾分析经显微手术治疗的28例桥小脑角大型及巨大型脑膜瘤：其中19例采用枕下乙状窦后入路，3例采用颞枕开颅乙状窦前入路，4例采用颞枕开颅颞下小脑幕入路，2例采用颞枕开颅与幕上、下联合入路：结果肿瘤全切除(SimpsonⅠ、Ⅱ级)22例，全切除率为78．6％。全组无手术死亡。术后症状改善者20例，症状基本同术前5例。26例随访6个月至4年，生活自理者23例(88．5%)，复发2例(7．7％)。结论合理选择手术入路，术中应用显微技术妥善处理和保护血管、神经、脑干等，能较理想地切除肿瘤和提高患者生存质量。     

颅底脑膜瘤的显微手术

目的对在显微镜下手术的颅底脑膜瘤患者进行回顾、分析，以提高其效果及生活质量。方法按肿瘤生长部位不同，选择不同的手术入路。在切瘤过程中常规使用Zeis显微镜进行手术操作。个别病例术前采用栓塞供瘤血管后再手术。部分未能全切者术后辅以γ-刀放射治疗。结果31例病例中全切除25例，大部分切除5例，部分切除1例。本组术后无死亡病例。神经功能及症状体征加重1例。3例原术前有癫痫发作患者经手术及术后行抗癫痫治疗后痊愈。余全部都有不同程度恢复、好转或痊愈。结论颅底脑膜瘤是血运异常丰富的实质性肿瘤，且颅底解剖复杂，凹凸不平，视野视角狭小多变，仍是专科的技术难点、热点之一。笔者认为：对血管异常丰富、风险较大者，应先行供瘤血管的栓塞后再手术。术中使用高速气磨钻扩大视野，骨窗要尽量贴近颅底，降低颅压及充分暴露肿瘤，使用显微操作技术，才能提高手术安全性及手术效果，减少并发症的发生，而显微技术是手术成功、安全的关键。     

显微手术切除颅内大型脑膜瘤并发症的防治

目的 探讨显微手术切除颅内大型脑膜瘤患者术后并发症的防治.方法 对从2001年11月至2007年1月经显微手术切除的75例颅内大型(最大径大于4.5 cm)脑膜瘤病例的临床资料进行回顾性分析,并对大型脑膜瘤显微手术的术后并发症的防治进行讨论.结果 脑膜瘤术后并发症有术后出血3例,癫痫3例,脑水肿6例,视力障碍2例,脑积水1例,偏瘫3例,电解质紊乱1例.结论 显微手术是目前治疗颅内大型脑膜瘤的首选方法,熟悉颅内解剖和熟练掌握显微手术外科技术是减少手术并发症的关键,对术后并发症密切的观察及预防,可以有效的提高原发病的治愈率、降低患者的死亡率、致残率、提高生存质量.     

蝶骨嵴内侧大型脑膜瘤的显微手术切除

目的 探讨蝶骨嵴内侧大型脑膜瘤的显微外科治疗方法。方法 回顾性分析28例蝶骨嵴内侧大型脑膜瘤显微外科手术。结果 21例达SimpsonⅠ、Ⅱ级切除，7例达Simpson Ⅲ级切除。术后偏瘫4例，植物生存2例，无死亡。结论 改良的翼点入路适于切除蝶骨嵴内侧大型脑膜瘤，掌握处理侵犯视神经、颈内动脉及海绵窦的手术技巧是提高肿瘤全切率的关键，但是对于明显侵犯颈内动脉、海绵窦等重要结构的肿瘤尚应考虑姑息的手术方式。     

皮质中央区脑膜瘤的显微手术治疗

目的探讨皮质中央区脑膜瘤的手术方法和治疗效果。方法回顾性总结经显微手术治疗的23例中央区脑膜瘤患者的临床资料。结果按Simpson切除标准,Ⅰ级切除9例(39.1%),Ⅱ级切除14例(60.9%)。2例患者并发颅内感染,3例发生下肢深静脉血栓,1例发生肺栓塞死亡。14例患者获随访3~26个月,2例复发再次手术,其余未见肿瘤复发。结论充分的术前影像学检查及评估,选择适当的手术入路,采用显微手术切除皮质中央区脑膜瘤,术中保护好中央沟静脉、避免脑功能区的损伤,能明显提高肿瘤的全切除率,减少严重并发症的发生,提高患者术后生存质量。     

镰旁脑膜瘤的显微手术治疗

目的探讨镰旁脑膜瘤的显微手术治疗方法 ,提高镰旁脑膜瘤的治疗效果。方法回顾性总结分析45例镰旁脑膜瘤的临床资料和显微手术治疗效果。结果肿瘤切除程度按S impson分级标准进行判定:45例患者中有42例为Ⅰ~Ⅱ级切除,3例为Ⅲ级切除,无手术死亡。随访6月~5年,全部病人均恢复正常生活,均无复发。结论显微手术治疗镰旁脑膜瘤时,注意选择适当的手术入路以及显露和切除肿瘤的技巧,可提高肿瘤的全切率,减少严重并发症,提高手术疗效。     

显微手术治疗斜坡脑膜瘤

显微手术治疗斜坡脑膜瘤杨卫忠，陈建屏，倪天瑞，石松生，张国良，刘才兴斜坡脑膜瘤临床少见，早期诊断和手术切除困难，手术并发症及死亡率高，一直为神经外科公认乙难题。我院经脑血管造影、ＣＴ、手术及病理证实１３例，总结如下。临床资料本组男５例，女８例。年龄２...     

窦旁脑膜瘤的显微手术治疗分析

目的分析窦旁脑膜瘤显微手术治疗效果。方法窦旁脑膜瘤患者28例,用显微手术方法进行治疗,分析患者的影像学资料和手术效果。结果 10例Ⅰ级切除,占35.71%,15例为Ⅱ级切除,占53.58%,1例为Ⅲ级切除,占3.57%,2例为Ⅳ级切除,占7.14%。患者术后均无头痛症状,7例单侧感觉障碍症状好转,8例一过性下肢瘫痪症状缓解,1例精神症状缓。术后1例出现瘤腔出血,对该患者进行对症治疗后恢复正常;8例患者术后出现肢体肌力下降,经对症治疗后均有不同程度的恢复;1例患者术后出现新发癫痫,术前伴发癫痫患者均恢复。患者术后Karnofsky评分为(76.89±5.83)分,术前为(87.24±5.72)分,两组比较,差异有统计学意义(P0.05);对所有患者进行随访,术后1年内无肿瘤复发患者,术后1年6个月和2年5个月分别有2例复发。结论窦旁脑膜瘤患者用显微手术治疗,可有效提高肿瘤切除成功率,保护颅内组织结构,降低并发症发生率。     

显微手术治疗大脑镰旁大型脑膜瘤

目的报道应用显微外科手术治疗大脑镰旁大型脑膜瘤的临床效果。方法根据大脑镰旁脑膜瘤的位置选择手术入路，应用显微手术切除大脑镰旁大型脑膜瘤136例。结果手术切除按Simpson分级，Ⅰ级98例，Ⅱ级35例，Ⅲ级3例，无手术死亡。随访7—42个月，实访113例，其中98例基本康复，10例生活基本自理，1例生活不能自理，4例死于其他疾病；复发1例，再次予手术切除，无再次复发。结论应用显微外科手术，可以提高大型镰旁脑膜瘤的治疗效果。     

矢状窦旁脑膜瘤22例显微手术治疗

目的 :分析总结矢状窦旁脑膜瘤显微手术治疗的方法及要点。方法 :经病理检查证实的矢状窦旁脑膜瘤 2 2例 ,男 10例 ,女 12例 ,年龄 2 1～ 68岁 ,平均年龄 42岁。肿瘤位于矢状窦旁左侧 9例 ,右侧 11例 ,同时累及双侧者 2例 ,位于矢状窦前 1/ 3者 4例 ,中 1/ 3者 15例 ,后 1/ 3者 3例。肿瘤大小 3～ 6.8cm。结果 :采用显微手术治疗 ,按Simpson切除分极标准 :Ⅰ级切除 6例 ,Ⅱ级切除 12例 ,Ⅲ级切除 4例 ,无手术死亡及新的神经功能障碍。随访 6月～ 5年未见肿瘤复发。结论 :显微外科技术损伤小能很好地保留神经功能 ,肿瘤切除可达SimpsonⅠ～Ⅱ级。     

颅底病变手术与缺损修复术患者围术期护理

目的探讨颅底病变手术与缺损修复术围术期的护理措施.方法对430例行颅底病变手术与缺损修复术的患者术前进行针对性心理疏导,手术区与供皮区的皮肤准备及全麻常规准备;术后加强生命体征监测,观察脑脊液漏、面瘫、感音神经性聋等症状,实施相应的护理.结果 428例均治愈出院;2例因病变累及颈内动脉,手术时血管破裂,行颈内动脉和颈总动脉结扎,术后发生脑疝而死亡.无1例发生护理并发症.结论颅底病变的手术治疗风险极大,而精心、细致、周到的护理是手术成功的重要保证.     

颅底病变手术与缺损修复术患者围术期护理

目的 探讨颅底病变手术与缺损修复术围术期的护理措施。方法 对430例行颅底病变手术与缺损修复术的患者术前进行针对性心理疏导．手术区与供皮区的皮肤准备及全麻常规准备；术后加强生命体征监测．观察脑脊液漏、面瘫、感音神经性聋等症状，实施相应的护理。结果 428例均治愈出院；2例因病变累及颈内动脉．手术时血管破裂．行颈内动脉和颈总动脉结扎．术后发生脑疝而死亡。无1例发生护理并发症。结论 颅底病变的手术治疗风险极大，而精心、细致、周到的护理是手术成功的重要保证。     

颅骨牵引患者翻身的舒适护理

目的 探讨颅骨牵引患者翻身的舒适护理.方法 对21例颅骨牵引患者翻身时进行心理疏导、舒适体位的摆放、减轻疼痛等舒适护理.结果 21例患者无1例发生护理并发症,在翻身过程中患者均感舒适,患者对护理工作满意率达100%.结论 通过舒适护理在颅骨牵引患者翻身中的应用,充分体现了"以人为本"的整体护理模式内涵,提高了护理质量.     

颅骨牵引患者翻身的舒适护理

目的探讨颅骨牵引患者翻身的舒适护理。方法对21例颅骨牵引患者翻身时进行心理疏导、舒适体位的摆放、减轻疼痛等舒适护理。结果21例患者无1例发生护理并发症，在翻身过程中患者均感舒适，患者对护理工作满意率达100％。结论通过舒适护理在颅骨牵引患者翻身中的应用，充分体现了“以人为本”的整体护理模式内涵，提高了护理质量。     

Linac Radiosurgery for Skull Base Meningiomas

Summary  Introduction. Skull base meningiomas present a difficult surgical challenge because of the high potential morbidity of radical surgical extirpation and their low potential for incapacitating symptomatology. The focal character of meningiomas makes stereotactic radiosurgery an attractive adjuvant treatment modality to resection. The purpose of this study was to evaluate the local control rates and complications in 56 patients with base of skull meningiomas undergoing radiosurgery.  Methods. Patients underwent radiosurgery using the dedicated stereotactic linear accelerator at the Brigham and Women's Hospital. Minimal peripheral doses of radiosurgery ranged from 12 to 18.5 Gy (mean 15 Gy). Doses were designed to conform to the frequently irregular tumor volumes using the X-Knife treatment planning system. Multiple isocenters were used when required to increase conformality of dose. For 36 patients (64%), radiosurgery was used as an adjunct to surgery; for 20 patients (36%) it was the primary treatment.  Results. Median followup was five years. Nineteen patients (34%) were improved clinically at follow-up; 32 (57%) were unchanged; and 5 patients (9%) developed new or worsened neurologic deficits. Serial imaging studies after radiosurgery showed a reduction in tumor volume in 23 patients (41%); 30 (54%) showed stable disease; 3 patients (5%) had tumors which increased in size (2 being outside the radiosurgery treatment site). The actuarial freedom from progression rate (defined as further tumor growth) was thus 95%, with a median imaging follow-up of 26 months (range, 6–66 months).  Although further follow-up is necessary, the results of this series clearly demonstrate that these lesions are feasible for treatment by modern radiosurgical techniques. Linac radiosurgery can stabilize skull base meningiomas, with decreased or unchanged tumor volumes on radiologic follow-up in approximately 95% of patients. Radiosurgery is a low-morbidity, effective technique as adjunct and sometimes primary treatment of small to moderate-sized meningiomas of the skull base.     

神经内镜下经鼻腔或口咽入路切除颅底脊索瘤的护理

对9例脊索瘤患者经鼻腔或口腔入路在神经内镜下行颅底脊索瘤切除术,在做好术前准备的基础上,加强心理护理、呼吸道管理及术后的伤口护理.结果患者均顺利完成手术且术后症状明显改善,无并发症发生,好转出院,随访3个月影像学资料未见异常.     

颅底涉眶内球后肿瘤病人的围术期护理

总结13例颅底涉眶内球后肿瘤病人的护理.提出术前应做好心理护理,术后密切观察病情,保持引流通畅,控制颅内压,做好眼部的护理并指导病人进行患眼功能训练.     

侵及颅底的头颈肿瘤患者围术期护理

目的探讨侵及颅底的头颈肿瘤患者围术期有效的护理方法及临床效果.方法对18例侵及颅底的头颈肿瘤手术患者进行针对性护理,包括心理护理、术前准备、术后体位引流、预防脑脊液漏、降低颅内压及受皮区护理.结果 18例均手术成功,手术时间3～8(5.2±0.4) h.术后2周发生出血3例,术后1周发生脑脊液漏1例,无修复组织瓣坏死.无手术死亡及严重颅脑并发症.住院20～60(41.6±5.3) d.结论采用娴熟的多学科护理知识护理该组患者,并发症减少,可提高手术成功率和患者生存质量.     

胃旁路术治疗肥胖症患者的护理

对5例肥胖症患者行胃旁路手术.结果 5例惠者手术顺利,平均体重由原130.3 kg降至115.0 kg,无明显不适出现.术前对患者肥胖程度进行评估,完善心理护理、术前准备,术后积极预防并发症,做好管道护理、饮食及活动指导等是提高手术成功率和确保减肥效果的重要保证.     

Gamma Knife Radiosurgery of Skull Base Meningiomas

Summary  Background. The standart surgical treatment of meningiomas is total resection of the tumour. The complete removal of skull base meningiomas can be difficult because of the proximity of cranial nerves. Stereotactic radiosurgery (SRS) is an effective therapy, either for adjuvant treatment in case of subtotal or partial tumour resection, or as solitary treatment in asymptomatic meningiomas.  Method. Between September 1992 and October 1995, SRS using the Leksell Gamma Knife was performed on 46 patients (f:m=35:15), ranging in age from 35 to 81 years, with skull base meningiomas at the Neurosurgical Department of the University of Vienna. According to the indication of gamma knife radiosurgery (GKRS) the patients (n=46) were devided into two subgroups. Group I (combined procedure: subtotal resection followed by GKRS as a planned procedure or because of a recurrent meningioma), group II (GKRS as the primary treatment). Histological examination of tumour tissue was available for 31 patients (67%) after surgery covering 25 benign (81%) and 6 malignant (19%) meningioma subtypes.  Findings. The overall tumour control rate after a mean follow-up period of 48 months (ranging from 36 to 76 months) was 96% (97.5% in benign and 83% in malignant meningiomas). Group I displayed a 96.7% tumour control rate, followed by group II with 93.3% respectively. Neurological follow-up showed an improvement in 33%, stable clinical course in 58% and a persistant deterioration of clinical symtoms in 9%. Remarkable neurological improvement after GKRS was observed in group II (47%), whereas in group I (26%) the amelioration of symptoms was less pronounced.  Interpretation. GKRS in meningiomas is a safe and effective treatment. A good tumour control and low morbidity rate was achieved in both groups (I, II) of our series, either as a primary or adjunctive therapeutic approach. The planned combination of microsurgery and GKRS extends the therapeutic spectrum in the treatment of meningiomas. Reduction of tumour volume, increasing the distance to the optical pathways and the knowledge of the actual growing tendency by histological evaluation of the tumour minimises the risk of morbidity and local regrowth. Small and sharply demarcated tumours are in general ideal candidates for single high dose-GKRS, even after failed surgery and radiation therapy, and in special cases also in larger tumour sizes with an adapted/reduced margine dose.