神经内镜辅助眶上锁孔入路切除鞍结节脑膜瘤

目的总结内镜辅助下经眶上锁孔入路显微手术切除鞍结节脑膜瘤的手术效果。方法13例鞍结节脑膜瘤采用眶上锁孔入路,先在显微镜直视下切除部分肿瘤,再在内镜辅助下切除残余肿瘤。结果肿瘤全切除12例（SimpsonⅠ级切除2例,Ⅱ级切除10例）,次全切除1例（SimpsonⅢ级切除）。11例术后随访3个月～6年,平均2.3年,〈1年恢复正常工作和生活9例,术后2年肿瘤复发1例,1年后恢复生活自理1例。结论内镜辅助下眶上锁孔入路切除鞍结节脑膜瘤克服了显微镜直视下的盲区,并发症少,创伤小,效果满意。     

眉间锁孔入路嗅沟脑膜瘤显微切除九例体会

我科于2000年10月至2005年2月共收治嗅沟脑膜瘤16例,其中经眉间锁孔入路显微全切除嗅沟脑膜瘤9例,术后反应轻,恢复快,效果满意,现报告如下。临床资料1.一般资料:本组男6例,女3例。年龄34~61岁,平均46.7岁。病程8个月~5年,平均3.7年。本组头痛5例;嗅觉障碍5例,其中嗅觉丧失3例,双侧嗅觉减退及单侧嗅觉减退各1例;精神异常4例,表现为性格改变、记忆力下降和行为异常;癫痫发作4例;视力下降3例。2.影像学检查:全部行头颅CT平扫,提示前颅窝底肿瘤双侧对称生长或略偏一侧生长,边界清楚、呈稍高密度影,周围程度不同的脑水肿,部分患者行CT增强扫描…     

内镜辅助眶上锁孔入路切除鞍上区肿瘤

目的 探讨内镜辅助眶上锁孔入路切除鞍上区肿瘤的显微手术技术,以最大限度地切除肿瘤,减少手术创伤。方法 16例鞍上区肿瘤患者依据手术前影像学检查结果,制订个体化手术方案,采用眉部皮肤切口,在眶上行直径2cm左右开颅,应用内镜辅助的显微手术技术切除病变。结果 16例患者经眶上锁孔入路技术获肿瘤全部切除,无手术并发症发生。结论 眶上锁孔入路可明显减少手术创伤、提供鞍上区足够的手术空间,有利于肿瘤的全切除。     

单侧额下入路显微切除大型及巨大型嗅沟脑膜瘤

目的 总结经单侧额下入路显微手术切除大型及巨大型嗅沟脑膜瘤的体会.方法 大型及巨大型嗅沟脑膜瘤患者31例,所有患者均经单侧额下入路开颅,显微手术切除病变.结果 Simpson Ⅰ级切除21例,Ⅱ级切除8例,Ⅲ级切除2例.结论 单侧额下入路显微手术能够用于切除大型及巨大型嗅沟脑膜瘤,与双侧额下入路比较,创伤小,恢复快,术后并发症少,符合微侵袭的理念.     

神经内镜辅助锁孔手术治疗颅内动脉瘤

目的 探讨神经内镜辅助下的锁孔手术治疗颅内动脉瘤的手术效果。方法 对14例颅内动脉瘤行动脉瘤夹闭术。经眉弓或翼点锁孔开颅，手术显微镜下初步暴露动脉瘤，置入神经内镜，观察动脉瘤颈及其周围结构的局部解剖，动脉瘤夹夹闭，再次置入神经内镜了解夹闭情况。结果 14例患者均无手术并发症，未出现新的神经系统症状与体征，全部恢复良好出院。结论 应用神经内镜辅助下的锁孔手术治疗颅内动脉瘤，可充分暴露动脉瘤及周围结构的局部解剖结构，手术创伤小，手术时间缩短，手术效果明显提高。     

眶上锁孔入路内窥镜辅助切除鞍上蔓延性垂体瘤及锁孔修复

目的 探索眶上入路、内窥镜辅助微创手术治疗鞍上蔓延性垂体瘤及锁孔修复的方法与技巧。方法 2001年2月～2003年3月，对9例鞍上蔓延性垂体瘤患者行眶上锁孔入路、显微镜下切除直视肿瘤部分，再辅用神经内窥镜经1、2间隙切除残余肿瘤。小骨瓣复位后用一枚钛钉固定。结果 常规显微镜下切除肿瘤后，经神经内窥镜探查时发现7例仍有不同程度的残瘤，辅用内镜进一步切除，6例全切除，3例次全切除。术后1周7例视力改善，2例无变化，无手术致残及死亡。6例随访6～22个月，半年后生活完全自理，恢复正常工作，视力提高0．3～0．5，3例激素恢复正常。6例复查MRI显示鞍区结构恢复良好，无肿瘤复发。骨窗修复稳固，且无切口并发症。结论 眶上锁孔人路可提供足够的颅内外操作空间；内窥镜辅助微创术提高了肿瘤的全切率及成功率，且有利于神经功能保护和减少并发症。用钛钉固定小骨瓣安全可靠，骨窗修复良好。     

内镜辅助眶上锁孔入路切除颅咽管瘤手术方法及术后护理对策

目的:总结内镜辅助眶上锁孔入路显微手术切除颅咽管瘤方法及术后护理对策.方法:采用眶上锁孔入路,内镜辅助显微技术切除颅咽管瘤11例.其中鞍内-鞍上型2例,鞍上-视定叉周围-脑室外型8例,脑室内-外型1例.结果:术后复查MRI,肿瘤全切除8例,次全切除3例,残余瘤体给予放疗,无手术死亡.随访3个月-2.3年,肿瘤复发1例.颅咽管瘤术前原有症状均有明显不同程度的好转.结论:内镜辅助眶上锁孔入路能清楚显露颅咽管瘤与周围结构的关系,提高了显微手术的精细度与安全性,及时有效的术后护理,提高了疾病的治愈率,防止并发症的发生.     

经乙状窦后锁孔入路的内镜解剖及临床应用

随着内镜及显微手术技术的不断成熟,神经内镜辅助下的显微神经外科手术已越来越受到国内外神经外科医师的青睐.在熟悉解剖知识的基础上,乙状窦后锁孔入路已被许多神经外科医师运用于三叉神经痛、面肌痉挛、听神经瘤等手术中.本文就乙状窦后锁孔入路的内镜解剖及临床应用予以综述.     

经眶上锁孔入路手术切除垂体腺瘤患者的护理

内镜辅助下经眶上锁孔入路手术切除垂体腺瘤8例，未发生与手术相关的并发症．住院7～10d。均临床治愈出院。提出术前充分准备。术后严密监测病情变化。做好切口的护理及防治并发症是促进患者康复的重要环节。     

经翼点入路显微手术切除嗅沟脑膜瘤

目的 介绍一种切除嗅沟脑膜瘤的微创手术方法。方法 采用经翼点入路显微手术切除嗅沟脑膜瘤20例(标准翼点入路6例，翼点锁孔入路14例)，观察肿瘤切除程度和手术效果。结果 全组手术显露良好，肿瘤均全切除(simpson Ⅰ级、Ⅱ级切除)，无额叶脑挫裂伤，仅8例手术输血各400ml，无严重并发症和手术死亡。结论 经翼点入路显微手术是治疗大部分嗅沟脑膜瘤的一种微创方法。     

The Role of the Pterional Approach in the Surgical Treatment of Olfactory Groove Meningiomas: A 20-year Experience

Background Olfactory groove meningiomas remain surgically challenging. The common microsurgical approaches suffer from late exposure of the neurovascular structures. Conversely, the pterional approach has the advantage of early dissection of the posterior neurovascular complex.Methods We reviewed the records of patients treated for olfactory groove meningioma in our department between 1991 and 2010. A total of 61 patients underwent removal of olfactory groove meningiomas via the pterional approach. These included 58 primary and 3 recurrent tumors. Mean overall follow-up time was 122 months.Results Early exposure and dissection of the internal carotid artery, middle cerebral artery, anterior cerebral artery, and optic nerve was feasible in all cases. Complete tumor removal was achieved in 60 patients. Morbidity and mortality rates were 26% and 1.6% respectively. Postoperative complications included epileptic seizures (five patients) and cerebrospinal fluid (CSF) leak (two patients). During follow-up, we recorded three tumor recurrences.Conclusions The pterional approach appears to be an excellent solution for the treatment of olfactory groove meningiomas. Its foremost advantage is early visualization of the posterior neurovascular complex. Moreover, it allows frontal sinus preservation and timely tumor devascularization and avoids excessive brain retraction. The pterional view is familiar to most neurosurgeons and therefore the transition to this technique is fairly straightforward.     

The unilateral frontotemporal approach for large and giant olfactory groove meningioma: Experience with 18 consecutive patients

AimAlthough the bifrontal approach used to be recommended for large olfactory groove meningioma (OGM), recent studies showed that large OGMs can also be resected safely via unilateral approaches. The present study aimed to discuss reasons for preferring a unilateral frontotemporal approach (UFTA), and the technical nuances and results of the UFTA, based on 18 cases.Material and methodsThe clinical and surgical data of patients who had been operated on for large (4–6 cm) or giant (>6 cm) OGM via a UFTA between 2011 and 2018 were retrospectively collected.ResultsIn all, 18 patients were included. All tumors were compatible with a diagnosis of OGM in the light of peri-operative examinations. 11 cases (61%) were large and 7 (39%) giant OGM; mean diameter was 6.1 cm (range, 4-10 cm). Resection extent was Simpson grade II in 14 cases (78%), grade III in 1 (5%), and grade IV in 3 (17%). Sixteen cases (89%) had no peri-operative complications, while 2 patients (11%) showed cerebrospinal fluid leakage and hemorrhagic deposition in the surgical area. There were no new neurological deficits nor deaths.ConclusionThe UFTA for OGM is a relatively safe and effective approach, ensuring a high total removal rate with low mortality and morbidity. This study, with a reasonable number of patients, is one of the few in the literature on the outcome of this approach.     

Giant olfactory groove meningioma: ophthalmological and cognitive outcome after bifrontal microsurgical approach

Object  Olfactory groove meningiomas arise in the midline along the dura of the cribriform plate and may reach a large size before producing symptoms. We conducted a retrospective study of patients with these lesions focused on pre- and post-operative investigations for ophthalmological, personality and cognitive disturbances. Methods  The authors reviewed 36 patients with giant olfactory groove meningiomas surgically treated via a bifrontal approach. Ophthalmological evaluation included visual acuity, fundoscopy and visual fields while psychological evaluation included a Mini-Mental State Examination. Data was collected before, 1 and 12 months after surgery. Formal pre- and post-operative ophthalmological examinations discovered visual deficits in 55.5% of the patients. Within the first month after surgery, improvement of visual acuity and of visual field deficits was observed. In post-operative neuropsychological testing, higher mental functions showed improvement. The most frequent post-operative complication was persistent rhinorrhoea in two patients. Conclusions  Results at longest follow up indicate that cognitive changes and visual deficits will improve in patients with giant olfactory groove meningiomas after a bifrontal approach, without additional neurological deficits. The Author’s didn’t receive any financial support in conjunction with the generation of their submission.     

Subtemporal Transtentorial Petrosalapex Approach for Giant Petroclival Meningiomas: Analyzation and Evaluation of the Clinical Application

With the advent of microsurgery and surgical techniques, along with the improvement in neuroimaging techniques and the microanatomy in cadaver study, improvement in terms of surgical morbidity and mortality has been remarkable; however, controversy still exists regarding the optimal surgical strategies for giant petroclival meningiomas (GPMs). We report a study of clinical and radiological features as well as the surgical findings and outcomes for patients with GPM treated at our institution over the past 6 years. During a 6-year period (April 2004 to March 2010), 16 patients with GPM underwent surgery by subtemporal transtentorial petrosal apex approach during which electrophysiological monitoring of cranial nerves and brainstem function were reviewed. There were nine females and seven males with a mean age of 56.9 years (range from 32 to 78 years). The most frequent clinical manifestations were headache (93.7%) and dizziness (93.7%). Regions and directions of tumor extension include clivus, parasellar, and cavernous sinus, as well as compression of brainstem, and so on. The trochlear nerve was totally wrapped in nine cases (56.2%). The postoperative Karnofsky Performance Scale (KPS) score was 76.3 ± 13.1. Mean maximum diameter of the tumors on magnetic resonance imaging was 5.23 cm (range, 4.5 to 6.2 cm). Subtemporal transtentorial petrosalapex approach was performed in all 16 cases. Gross total resection was achieved in 14 cases (87.5%) and subtotal resection in 2 cases (12.5%) with no resultant mortality. Follow-up data were available for all 16 patients, with a mean follow-up period of 28.8 months (range from 4 to 69 months), of which 11 (68.75%) lived a normal life (KPS, 80–100). Our suggestion is that GPM could be completely resected by subtemporal transtentorial petrosalapex approach. The surgical strategy of GPM should be focused on survival and postoperative quality of life. Microneurosurgical technique plays a key role in tumor resection and preservation of nerve function. Intraoperative electrophysiological monitoring also contributes dramatically to the preservation of the nerve function. Complete resection of the tumor should be attempted at the first operation. Any remnant is treated by radiosurgery.     

小骨窗显微手术切除大型桥小脑角肿瘤及神经功能保护

目的探讨大型（直径≥3cm）桥小脑角肿瘤的小骨窗显微手术切除方法及神经功能保护。方法回顾性分析经乙状窦后入路小骨窗显微手术切除的32例大型桥小脑角肿瘤患者的临床资料,肿瘤全切除28例（87．5％）,次全切除4例（12．5％）。结果本组无手术死亡病例。面神经解剖保留率为93．8％（30／32）,面神经功能（House—BrackmannI、Ⅱ级）保留率为78．1％（25／32）,听神经解剖保留率为87．5％（28／32）,听力保留率68．8％（22／32）。结论采用乙状窦后入路小骨窗显微手术切除大型桥小脑角肿瘤是一种安全、有效的手术方法,在保留神经功能完整性的前提下应尽量切除肿瘤。