经枕下乙状窦后入路桥小脑角脑膜瘤的显微外科手术治疗

目的：探讨桥小脑角脑膜瘤的临床特点及经枕下乙状窦后入路行显微外科手术的手术技巧。方法：对29例桥小脑角脑膜瘤患者经枕下乙状窦后入路行显微外科手术，观察切除程度、手术前后神经功能变化及主要并发症。结果：肿瘤全切（SimpsonⅠ、Ⅱ级）16例，大部分切除10例，部分切除3例；大部分切除或部分切除者术后均行1刀治疗。术后临床症状改善者20例，症状基本同术前及加重者9例；术后出现脑脊液漏2例，肺部感染4例，后组颅神经损伤3例，颅内感染1例，昏迷伴偏瘫1例，死亡1例。结论：对于桥小脑角脑膜瘤可选择经枕下乙状窦后的手术入路，术中妥善处理大血管，注意神经和脑干的保护，提高肿瘤切除的技巧，针对性预防和处理术后并发症，是保证手术疗效和患者术后生活质量的关键。     

超声刀显微外科治疗桥脑小脑角脑膜瘤35例体会

目的回顾超声刀配合显微镜下切除桥脑小脑角区脑膜瘤35例的手术治疗经验。方法35例超声刀配合显微镜下经枕下乙状窦后入路、经颞枕幕上、下联合入路或枕下入路等切除肿瘤。结果35例中全切除（Ⅰ级、Ⅱ级切除）28例，大部分切除7例。术后疗效满意。结论：超声刀配合显微镜下手术切除治疗桥脑小脑角脑膜瘤是提高手术效果、降低死亡率的关键。     

矢状窦旁及大脑镰旁脑膜瘤的显微手术治疗76例体会

背景与目的：目前大型和复杂的矢状窦旁及大脑镰旁脑膜瘤手术治疗仍有一定难度,本文通过总结76例手术体会,探讨矢状窦旁及大脑镰旁脑膜瘤的手术治疗方法和技巧。方法：回顾性总结分析我科自2003年5月至2008年12月收治的76例矢状窦旁及大脑镰旁脑膜瘤的临床资料、诊断、手术方法及其疗效。结果：本组全部采用显微手术治疗,手术全切71例（93．4％）,其中SimpsonⅠ级切除21例（27．6％）,SimpsonⅡ级切除45例（59．2％）,SimpsonⅢ级切除5例（6．6％）,无手术死亡,术后随访6～72个月。结论：矢状窦旁及大脑镰旁脑膜瘤应力争达到SimpsonⅠ级切除;良好的手术暴露,熟练的显微手术技巧,矢状窦和中央沟静脉的妥善处理和保护,避免脑皮质损伤．是提高矢状窦旁及大脑镰旁脑膜瘤手术全切率和手术疗效的重要因素。     

显微外科手术治疗三叉神经痛型桥小脑角胆脂瘤27例经验

背景与目的：颅内胆脂瘤多位于桥小脑角,桥小脑角胆脂瘤是继发性三叉神经痛最常见原因,本研究探讨三又神经痛型桥小脑角胆脂瘤的临床特点、有效诊断和治疗的方法。方法：回顾性总结27例三叉神经痛型桥小脑角胆脂瘤的诊治经过及疗效。结果：CT或（和）MRI确诊后行手术治疗,19例桥小脑角胆脂瘤得以全切,8例次全切,术后所有三叉神经痛及面肌痉挛完全消失,听力障碍明显好转。跟踪随访。1年后1例三叉神经痛复发。结论：三叉神经痛型桥小脑角胆脂瘤以三叉神经痛为首发症状．临床表现多不典型．年轻的患者如有三叉神经痛的症状时要高度怀疑此病,CT、MRI可提供诊断依据,常用的手术入路为枕下乙状窦后入路．手术方法得当．肿瘤切除后三叉神经痛的症状即停止。     

显微神经外科联合术后伽马刀治疗窦旁脑膜瘤的临床观察

目的 探讨显微神经外科手术联合术后伽马刀治疗窦旁脑膜瘤的疗效和安全性。方法 2008年6月至2013年7月34例窦旁脑膜瘤患者行显微手术切除,术后1～3个月复查头部MRI,对SimpsonⅡ级和Ⅲ级切除者追加伽马刀治疗。结果 34例患者中,Simpson Ⅰ级切除9例,Simpson Ⅱ级切除20例,Simpson Ⅲ级切除5例。术后并发轻瘫9例,无术后脑肿胀、重残和死亡病例。术后对Simpson Ⅱ级和Ⅲ级切除的25例患者进行伽马刀治疗（剂量8～20Gy）。术后随访6～36个月, 3例复发,其中Simpson Ⅱ级1例,Simpson Ⅲ级2例。结论 显微神经外科手术联合术后伽马刀治疗窦旁脑膜瘤安全性较好,复发率低。     

小脑蚓部区肿瘤显微外科手术治疗31例分析

背景与目的：小脑蚓部是后颅窝肿瘤常见好发部位，本文探讨小脑蚓部区肿瘤显微外科手术方法和影响手术效果的因素。方法：同顾性分析31例经显微外科手术和病理证实的小脑蚓部区肿瘤的临床特点，影像学特征和手术疗效。结果：本组31例，手术全切除22例，次全切除8例，大部分切除1例。术中行侧脑室-小脑延髓池分流术9例，术后放疗8例，化疗9例，伽玛刀治疗6例。31例中，1例脑膜瘤术后1天出现进行性意识障碍、小脑幕上疝，MRI检查提示局部血肿及脑水肿，经手术减压加血肿清除治愈。本组25例获得随访2-35个月（平均22个月），16例T作、学习正常，7例1年后复发，2例死亡。结论：充分认识小脑蚓部区肿瘤的临床特征，正确运用湿微外科技术和手术处理原则，是治疗小脑蚓部区肿瘤的关键，术后给予化疗和放疗能有效延长患者的生存时间，提高生存质量。     

结肠癌并急性结肠梗阻的治疗（附119例报告）

目的 探讨结肠癌并发急性结肠梗阻治疗的有关问题。方法 回顾性分析119例结肠癌并发急性结肠梗阻患者的临床资料。结果 119例结肠癌并发性结肠梗阻肿瘤I期切除81例（68％），其中I期吻合50例（61．7％），近期痊愈78例（96．3％），死亡3例（3．7％），吻合口瘘3例（6％）；I期造瘘12例，其中Ⅱ期切除肿瘤5例（41．8％），死亡2例（16．8％），永久性造瘘16例，径术6例，好转16例（72．7％），死亡6例（27．3％）。结论 I期切除吻合术是治疗结肠癌并急性结肠梗阻的理想的可行的手术方式。术中肠道减压和清洁灌洗能够提高肿瘤I期切除吻合率。围手术期的合理治疗是降低其病死率，减少并发症，提高病人术后生存期的关键因素。     

内侧型蝶骨嵴脑膜瘤显微神经外科手术中血管和神经的保护

背景与目的：内侧型蝶骨嵴脑膜瘤手术全切难度大,并发症较多,是颅底外科的难题之。本研究探讨内侧型蝶骨嵴脑膜瘤显微外科手术中血管和神经的保护,进一步减少并发症．以提高肿瘤切除率。方法：采用经翼点入路对35例内侧型蝶骨嵴脑膜瘤进行显微神经外科手术切除．观察疗效和并发症,对与手术相关的血管和神经保护方法进行总结。结果：本组SimpsonⅠ级切除22例（62．9％）,SimpsonⅡ级切除9例（25．7％）,SimpsonⅢ级切除4例（11-4％）,无手术死亡。术前视力明显减退或视野缺损的22例中,术后明显好转16例,术后轻瘫2例、动眼神经麻痹1例,经积极治疗出院时恢复良好。结论：准确全面的术前评估,术中对视神经、海绵窦及其内神经、颈内动脉及其分支的保护．是提高内侧型蝶骨嵴脑膜瘤全切率、术后神经功能改善恢复和减少手术并发症发生的关键技术．     

直肠癌术后局部复发的外科治疗

目的：探讨直肠癌术后局部复发的外科治疗。方法：回顾性分析58例直肠癌根治术后局部复发患者的临床资料。结果：58例患者中再次手术15例（25．8％），其中根治性切除5例（8．6％），姑息性切除6例（10．3％），单纯结肠造瘘4例（6．9％），15例再手术患者的3年，5年生存率分别为46．7％和26．7％，非手术切除治疗者的3年、5年生态率分别为6．9％和0，有非常显著性差异（P＜0．01），结论：直肠癌根治术后2－3年内应严密随诊，对局部复发者再次行手术切除是首选的治疗方法。     

枕下乙状窦后入路切除听神经瘤30例体会

背景与目的：听神经瘤是中枢神经系统常见的良性肿瘤之一,其治疗有几种不同的手术入路,但枕下乙状窦后入路应用最为广泛。本研究探讨经枕下乙状窦后入路治疗听神经瘤的显微外科技术及疗效。方法：回顾性分析30例听神经瘤患者临床资料．均经枕下乙状窦后入路行显微手术切除,术中显露横窦和乙状窦,放出枕大池脑脊液．再行显微镜下分离及切除肿瘤．分析显微手术过程及治疗效果。结果：术后无1例患者死亡,肿瘤总体全切率90．0％（27／30）,次全切除3例．面神经解剖保留率为93．33％,面神经功能保留率为66．7％。结论：掌握桥小脑角区的解剖学特征、显微手术技巧以及电生理监测在听神经瘤切除和颅神经功能保护中具有重要意义。     

桥小脑角区占位性病变的MRI诊断--附78例分析

背景与目的:桥小脑角区肿瘤具有来源多及种类多的特点,给诊断带来了许多困难,本文探讨桥小脑区占位性病变的M RI诊断。方法:收集我院经病理证实的桥小脑区占位性病变78例,分析其M RI特征。结果:78例患者中,单侧听神经瘤48例(61.5%),双侧听神经瘤5例(6.4%),脑膜瘤12例(15.4%),三叉神经瘤4例(5.1%),血管母细胞瘤3例(3.8%),脂肪瘤3例(3.8%),黑色素瘤2例(2.6%),髓母细胞瘤1例(1.3%)。根据解剖部位、肿瘤病变特征和M RI信号特点,能对大多数桥小脑区肿瘤进行定性诊断。结论:M RI在桥小脑角区占位性病变的诊断中具有重要作用。     

桥小脑角区占位性病变的MRI鉴别诊断

Objective： To explore the value of magnetic resonance imaging （MRI） in diagnosis of occupying lesions in cerebellopontine angle area. Methods： MRI records of 78 patients with pathologically confirmed occupied lesions in cerebellopontine angle area were analyzed. Results： Of the 78 cases, 48 （61.5%） were unilateral acoustic neuroma, 5 （6.4%） were bilateral acoustic neuroma, 12 （15.4%） were meningioma, 4 （5.1%） were trigeminal neuroma, 3 （3.8%） were lipoma, 2 （2.6%） were melanoma, and 1 （1.3%） was medulloblastoma. According to the anatomic site, tumor lesion character, and MRI signal, the majority of cerebellopontine angle area tumors were diagnosed accurately. Conclusion： MRI plays an important role in diagnosis of occupying lesions in cerebellopontine angle area.     

透明细胞型脑膜瘤临床病理分析

目的:探讨透明细胞型脑膜瘤的临床病理特征、诊断及鉴别诊断。方法:回顾性分析6例透明细胞型脑膜瘤患者临床及影像学资料、组织学形态及免疫组化结果,并进行随访。结果:患者6例,男性2例,女性4例,手术时年龄14～39岁（平均年龄:26岁）。发生部位分别为桥小脑角区5例（左侧1例,右侧4例,其中1例为多发,包括右侧桥小脑角区及双额叶间大脑镰旁）,骶尾部1例。临床症状与肿瘤部位相关。肿瘤最大直径约3.3~17.2 cm。手术方式分别是3例完全切除,2例次全切除,1例为穿刺活检。病理学检查示瘤细胞呈片状排列,中间交织着透明变性的块状胶原,细胞呈多边形,胞质透明,胞核居中。免疫组化显示EMA（6/6）、PR（5/6）、Vimentin（6/6）阳性,GFAP、S-100蛋白、CK均为阴性,特殊染色显示PAS(+),D-PAS（-）。Ki67标记指数2%~10%。3例获得随访资料,随访时间6~25个月,1例（例2）完全切除术后死亡,1例（例3）次全切除术后进行放射治疗,现带病生存,1例（例6）完全切除术后无病生存。结论:透明细胞型脑膜瘤是一种罕见的脑膜瘤类型,诊断时依靠形态学结合免疫组化染色,需与胞浆透亮的脑肿瘤鉴别。该类型肿瘤好发于年轻人,复发率高,建议进行影像学监测。     

Benign meningioma: partially resected, biopsied, and recurrent intracranial tumors treated with combined proton and photon radiotherapy

Purpose/Objective: To evaluate the recurrence-free survival and complications of combined proton and photon radiotherapy of patients with incompletely resected or recurrent histologically-confirmed benign meningioma.

Methods and Materials: Between May 1981 and November 1996, 46 patients with partially resected, biopsied, or recurrent meningiomas (median age of 50 years; range 11–74 years) were treated with combined photon and 160-MeV proton beam therapy at the Massachusetts General Hospital (MGH) and the Harvard Cyclotron Laboratory, using computed tomography-based conformal 3D treatment planning. Nine patients were treated after incomplete tumor resection, 8 patients after tumor biopsy only, and 29 patients after tumor recurrence following gross total (10/29 patients) or progression after subtotal (19/29 patients) resection. All patients were classified as benign meningioma on review slides at MGH. The median dose to the macroscopic gross tumor volume was 59.0 CGE (range 53.1–74.1 CGE, CGE = proton Gy × 1.1 RBE). The median follow-up was 53 months (range 12–207).

Results: Overall survival at 5 and 10 years was 93 and 77%, respectively, and the recurrence-free rate at 5 and 10 years was 100% and 88%, respectively. Survival without severe toxicity was 80% at 5 and 10 years. Three patients presented with local tumor recurrence at 61, 95, and 125 months. One patient developed distant intradural metastasis at 21 and 88 months. No patient died from recurrent meningioma; however, 4 patients died of other causes. A fifth patient died from a brainstem necrosis after 22 months. Eight patients developed severe long-term toxicity from radiotherapy, including ophthalmologic (4 patients), neurologic (4 patients), and otologic (2 patients) complications. All patients with ophthalmologic toxicity received doses higher than those allowed for the optic nerve structures in the current protocol.

Conclusion: Combined proton and photon radiotherapy is an effective treatment for patients with recurrent or incompletely resected benign intracranial menigiomas. Observed toxicity appears to be dose-related; with currently employed dose constraints, toxicity should not exceed that seen in patients treated with conformal fractionated supervoltage photon radiotherapy.     

神经内镜辅助显微手术治疗桥小脑角表皮样囊肿的安全性和可行性

目的：探讨神经内镜辅助显微手术治疗桥小脑角表皮样囊肿的安全性和可行性。方法回顾性分析行神经内镜辅助显微手术治疗的27例桥小脑角区表皮样囊肿患者资料，观察治疗效果。结果术前 CT和 MRI 检查明确显示肿瘤形态、大小、边界和血流信号情况；22例全切，5例次全切。24例临床症状明显改善，3例好转，并发症发生率为7.40％。结论神经内镜辅助显微手术治疗桥小脑角表皮样囊肿安全性和可行性均较高，可行 CT 和 MRI 扫描为手术提供信息。     

Clear cell meningioma with frequent chordoid features and aggressive behavior: a clinicopathologic study of ten cases at a single institution

Clear cell meningioma is an uncommon variant of meningiomas that often occurs in young patients, shows a proclivity for spinal intradural extramedullary and cerebellopontine angle, and follows an aggressive clinical course. We render clinicopathologic features of ten cases of this rare tumor to further elucidate its behavior. Fifteen specimens of clear cell meningioma belonging to ten patients were obtained at a single institution from 2001 to 2009. Correlations of histologic parameters, immunohistochemical study, and clinical features were assessed. This series included eight men and two women with a mean age of 62.1 years at the first surgery. The mean post-operative follow-up period was 3.9 years. Four patients (40%) had single or multiple local tumor recurrences. The mean time to recurrence was 2.3 years. Seven tumors (46.7%) were combined with chordoid features. There was a wide range of MIB-1 labeling indices (4.4–33.5%, mean 15.8%), which were higher in recurrent tumors, tumors with chordoid features, and tumors with necrosis. There was no correlation between MIB-1 labeling indices and brain invasion. The study illustrates aggressive behavior of clear cell meningioma and frequently combined chordoid features in our cases.     

Malignant meningioma of the cerebellopontine angle in a 2-year-old girl:a case report and literature review

Meningioma is a common intracranial tumor in adults.Pediatric cases account for approximately 1.5% of all intracranial meningiomas,and very few cases show malignant histological features.Primary pediatric malignant meningioma in the cerebellopontine angle is extremely uncommon.Herein,we report a 2-yearold girl with malignant meningioma in the cerebellopontine angle.The clinical features,diagnosis,and treatment protocol are discussed.     

Comparative analysis of survival, treatment, cost and resource use among patients newly diagnosed with brain metastasis by initial primary cancer

Choroid plexus papillomas (CPPs) are rare, indolent lesions that comprise less than 0.5 % of intracranial tumors. We sought to assess the long-term outcomes and associated surgical complications at our institution. A review of the University of California, San Francisco (UCSF) Brain Tumor Research Center (BTRC) database was performed to identify a cohort of patients treated for CPP from 1997 to 2011. Patients were grouped based on tumor location and extent of resection. Outcomes including progression-free survival and surgical complications were assessed. We identified 24 patients (16 female, 8 male) ranging in age from 6 months to 55 years (median 29 years) treated at our institution. Tumors were found in the following locations: 16 (67 %) fourth ventricle/cerebellopontine angle; 7 (29 %) lateral ventricle; 1 (4 %) third ventricle. Gross total resection (GTR) was achieved in 20 patients (83 %) with subtotal resection (STR) in 4 (17 %). Median follow-up time was 2.8 years with 3 recurrences identified at 1.6, 3.3, and 8.5 years. Extent of resection and tumor location were not associated with recurrence. There was one new permanent neurologic deficit detected after surgery. All patients were alive at most recent follow-up. Attempted gross total resection is the standard treatment for CPPs and generally associated with excellent outcomes. Since recurrences are rare, even among patients who undergo STR, radiation may be reserved for cases of tumor progression. This modern experience at a tertiary care center performed exclusively during the MRI-era demonstrates that CPPs can be safely removed with minimal morbidity and good tumor control.     

Asymptomatic cerebellopontine angle and lateral ventricle metastases from renal cell carcinoma: case report and literature review

Tumors rarely metastasize to the cerebellopontine angle. We report the first instance of simultaneous metastasis of renal cell carcinoma to the cerebellopontine angle and the lateral ventricle. A 51-year-old man presented with anemia and fatigue owing to stomach metastases from renal cell carcinoma 8 years after undergoing partial left nephrectomy for grade II clear cell renal carcinoma and radical right nephrectomy for grade III clear cell renal carcinoma. He also suffered metastases to the lung, both adrenal glands, the L-3 vertebra, and the brain (asymptomatic, but revealed by magnetic resonance imaging): a 1-cm (maximum diameter) mass in the left medullary cistern and a 2-cm (maximum diameter) mass in the right lateral ventricle trigone. Both brain lesions were treated with stereotactic radiosurgery, followed by gross-total resection of the right trigonal mass 7 months later. Both tumors shrank significantly, but the patient died from progressive systemic cancer 1 year after diagnosis of brain metastasis.     

Angiosarcoma arising in schwannoma of cerebellopontine angle and later associating with meningioma in a patient with neurofibromatosis type 2

Here, we describe an extremely rare case of angiosarcoma arising in schwannoma of the cerebellopontine angle and later associating with meningioma in a patient with neurofibromatosis type 2. A 33-year-old disabled Japanese man with right drop foot after surgery for an unspecified tumor demonstrated multiple tumors, suspected to be schwannoma, in the bilateral cerebellopontine angles, the cervical and lumbar spinal cord, and on the right nuchal skin. Also present were several tumors in the medulla and thoracic spinal cord suspected to be ependymoma or astrocytoma. The patient was diagnosed with neurofibromatosis type 2 according to the diagnostic criteria by the U.S. National Institutes of Health. The bilateral tumors in the cerebellopontine angle were resected to reduce symptoms and brain stem compression. Histopathological analysis revealed angiosarcoma arising in schwannoma of the bilateral tumors, and angiosarcoma was proportionally larger in the right tumor than in the left. At age 36, the patient underwent a second resection of the regrown tumor in the left cerebellopontine angle, and histopathology demonstrated mixed angiosarcoma and meningioma. That angiosarcoma arises in schwannoma is a pathogenesis within the realm of conjecture, especially that the phenomenon of mixed meningioma and angiosarcoma has not been reported to date.