改良翼点入路显微切除鞍结节脑膜瘤

Objective To summarize the experience with modified transpterygoid craniotomy for microsurgical resection of tuberculum sellae meningiomas. Methods The clinical data were retrospectively analyzed in 26 patients with tuberculum sellae meningiomas admitted between January, 2001 and April, 2007 in our hospital to receive microsurgical meningioma removal using a modified transpterional approach. The basal part of the tumor was firstly coagulated and dissected to control the blood supply of the lesion. Through the cerebral cisterns in the sellar region and the interfaces between the tumor and the adjacent structures, the tumor was removed to the greatest possible extent with minimal invasiveness to the neighboring structures. Results Simpson grade Ⅰ resection was achieved in 11 patients, grade Ⅱ resection in 14 patients, and grade Ⅲ resection in 1 patient. The visual acuity and the optic field were improved in 23 patients, and remained unchanged in 1 patient after the operation. Two patients had postoperative visual acuity deterioration, which was improved after appropriate treatment. Seven patients developed diabetes insipidus after the operation, and gradually recovered after symptomatic treatments for about 10 days without fatal consequences. Follow-up for 6 months to 5 years found no recurrence of meningiomas in these patients. Conclusions The modified transpterional approach provides excellent exposure of the middle fossa, anterior cranial fossa, saddle and parasellar areas, and is effective for different types of tuberculum seilae meningiomas with increased total resection rate and reduced postoperative complications.     

经耳前颧弓硬膜外入路切除海绵窦肿瘤60例分析

目的 总结回顾2002年至2009年经治的海绵窦病变60例的临床特点、手术人路及手术效果.方法 神经鞘瘤18例,海绵状血管瘤23例,皮样囊肿9例,脑膜瘤4例,脊索瘤3例,垂体瘤3例.均经耳前颧弓硬膜外入路切除.结果 神经鞘瘤18均全切,海绵状血管瘤23例,全切18例,5例有残留.皮样囊肿9例全切,脑膜瘤4例,全切3例,次全切1例.脊索瘤3例,结合经鼻蝶窦入路手术,均达到了全切.垂体瘤3例全切.结论 经耳前颧弓硬膜外入路切除海绵窦病变是一个理想的手术入路,可以充分显露病变,减少对脑组织的牵拉,也可以明确Ⅲ～Ⅵ脑神经和颈内动脉的位置,减少神经和血管损伤的概率.对与动脉或神经粘连无法彻底切除的病变可以辅以立体定向放射治疗.

Abstract：

Objective To review our experience of microsurgery for 60 cavernous sinus tumors from 2002 to 2009.The clinical features,surgical techniques and outcome of cavernous sinus tumor in 60 cases were investigated retrospectively.Methods The patients included 23 hemangiomas,18 shwannomas,9 dermoid cysts,4 meningiomas,3 chordomas,3 pituitary adenomas.AIl the tumors were removed with subtomperal preauricular extradural approach.Results The tumors were removed satisfactorily.The shwannomas were totally removed. The hemangiomas were totally removed in 18,near-totally removed in 5 cases.Nine dermoid cysts were removed totally.For the 4 meningiomas,3 were removed completely,neartotallv removed in 1 cases.The 3 Chordomas were resected near-totally and achieved a completely removal with combined approach.Conclusion The subtomperal preauricular extradural approach is a rational choice.It can reveal the cranial nerve branches and artery at an early stage so that cranial nerves Ⅲ～Ⅵ and internal carotid artery can be preserved during operation.The tumor exposure is ideal and brain traction and contusion are slightly.The adjunctive radiotherapy is demanded for residual tumors adhering to nerves and arteries severely.     

经额叶侧脑室脉络膜裂入路丘脑胶质瘤切除术

目的 研究经额叶侧脑室脉络膜裂入路切除丘脑胶质瘤的手术方法.方法 采用经额叶侧脑室脉络膜裂入路切除丘脑胶质瘤20例,在冠状缝前约1.5 cm、冠状缝后不超过1 cm内分离额上沟并切除部分额中回,进入侧脑室体部.根据丘脑肿瘤主体与脉络膜裂的关系,4例在脉络膜裂的内侧纵形进入第三脑室,切除突出于第三脑室的丘脑肿瘤;16例在脉络膜裂的外侧切除丘脑肿瘤.结果 1例肿瘤切除范围小于50%,余19例切除范围大于90%;病理结果:胶质瘤Ⅱ级3例,Ⅲ级9例,Ⅳ级8例.围手术期死亡1例.随访无癫痫发生,GOS评分:良好16例,重残1例,死亡2例.结论 丘脑胶质瘤的手术仍存在较大的困难,采用经额叶侧脑室脉络膜裂入路切除丘脑胶质瘤,取得较理想的效果.

Abstract：

Objective To evaluate the effect of surgical treatment of thalamic gliomas via transcortico -ventriculo -choroidal approach. Methods 20 cases of thalamic gliomas were included in this group. The part of middle frontal gyrus was removed to get to the lateral ventricule and from there, according to the direction of the tumor encroaching and relationship with choroidal fissure, the tumor was removed directly or through the third ventricle. Results Partial resection ( less than 50% ) was performed in 1 case. Subtotal resection (more than 90% ) was performed in 19 cases. 3 tumors were low -grade gliomas, 17 high - grade. There were two postoperative death. During follow - up period, 16 cases lived in good neurological condition, one severe condition who needed help completely. Another case died of glioblastoma multiforme. Conclusions Transcortico - ventriculo - choroidal approach is safe and effective for getting a good view in the surgical treatment of thalamic glioma.     

脑干血管畸形的显微手术治疗(附19例报告)

目的 探讨脑干血管畸形的显微外科手术治疗方法和预后.方法 显微手术切除脑干血管畸形19例.6例经枕下正中第四脑室底入路切除;9例经枕下乙状窦后入路切除;3例经小脑延髓裂入路切除;1例经枕下正中入路上抬蚓垂后切除.结果 19例病灶均镜下全切,其中海绵状血管瘤15例,动静脉畸形4例.13例症状改善,5例出现并发症,1例因下呼吸道感染死亡.随访中GOS 5分15例,GOS 4分2例,GOS 3分1例.MRI复查无病灶残留.结论 在恰当选择手术适应证、手术时机和手术入路的基础上,运用娴熟的显微外科技术,脑干血管畸形的手术治疗结果是令人满意的.

Abstract：

Objective To investigate the microsurgical treatment of brainstem vascular malformation and evaluate the surgical outcome. Method Brain stem vascular malformations in 19 cases were resected by microsurgical techniques. Six cases of cavernous malformations ( CM ) in the dorsal of pons and medulla underwent operations via through the base of the forth ventrical approach. Another nine cases of CM in lateral and ventral lateral pons were treated via suboccipito - retrosigmoid approach. Three cases of arteriovenous malformation(AVM) in cerebellomedullary fissure were treated via telovelar approach. One case of AVM in the dosal medulla were resected via transvermian approach. Results All the lesions were totally resected. Pathologic diagnosis were CM( 15 cases) and AVM(4 cases). The diameter of all the CM were less than 1 centimeter. One AVM was 1.5 centimeter in diameter, the other two lesions was 2. 0 centimeter, the last one was 2. 5 centimeter. The functional disorders were improved after operation in 13 cases. Complications appeared in five patients, which improved between one week and three months. One patient died of sever pneumonia. During two months to six years after operation, the brainstem vascular malformation didn't recrudesce and re - bleed. No one patient appeared new syndromes. Conclusions The microsurgical management of brainstem vascular malformation can effectively prevent re - bleeding. Selecting different surgical approach basing on the locations can reduce the neurofunction damage. In order to accelerate the recovery of damaged brainstem, early surgery should be choosen for the patients with surgical indications. Basing on the correct choice of surgical indications, using the extensive knowledge of microanatomy,new concept of minimal invasive surgery and skillful microsurgical techniques, the surgical results of brainstem vascular malformation are satisfactory.     

经翼点硬膜外入路切除前床突脑膜瘤

目的 探讨经翼点硬脑膜外入路在前床突区脑膜瘤切除术中的应用. 方法 南京医科大学附属脑科医院神经外科自2007年6月至2010年5月采用经翼点硬脑膜外入路手术切除前床突脑膜瘤17例,回顾性分析患者的临床资料和疗效. 结果 本组肿瘤全切除12例,次全切除4例,大部切除1例.15例视力障碍患者中11例视力、视野改善,3例无明显变化,1例视力下降.本组无死亡病例. 结论 经翼点硬脑膜外入路手术切除前床突脑膜瘤,有利于肿瘤基底部的血供阻断和前床突下肿瘤与颈内动脉的分离.

Abstract：

Objective To investigate the application of pterional extradural approach in surgery of anterior clinoidal meningioma resection. Methods The clinical data and treatment efficacy of 17 patients with clinoidal meningiomas, admitted to our hospital and performed surgery via a pterional extradural approach from June 2007 to May 2010, were retrospectively analyzed. Results Of the 17 patients with clinoidal meningiomas, 12 received total removal of the tumors, 4 subtotal removal and 1 partial removal. Of the 15 patients with pre-operative visual failure, 11 were markedly improved in visual acuity and visual field, 3 with no obvious changes and 1 with hypopsia. No death was noted.Conclusion The pterional extradural approach in anterior clinoidal meningioma resection can help to block the blood supply to the tumor base and detach the infra-clinoidal tumor from the internal carotid artery.     

枕大孔区肿瘤的分型及手术入路选择

目的 探讨枕大孔区肿瘤的分型及手术入路.方法 回顾性分析显微手术治疗的43例枕骨大孔区肿瘤,根据肿瘤位置分为:Ⅰ型(背侧)和Ⅱ型(腹侧),Ⅰ型又分为Ⅰ a(髓外)、Ⅰ b(髓内)、Ⅰ c(髓内外)三型,Ⅱ型又分为Ⅱa(髓外)和Ⅱb(髓内)两型.对于17例Ⅰ型患者选择后正中入路,26例Ⅱ型患者选择远外侧入路.结果 全切肿瘤35例(81%),无手术死亡,随访期内无肿瘤复发.临床症状改善32例;保持原有症状3例;加重8例,包括出现新的脑神经症状、肢体运动障碍和呼吸困难.结论 枕大孔区肿瘤的术前分型有助于手术入路的选择和判断手术效果,Ⅰ型多选择后正中入路,Ⅱ型选择远外侧入路.

Abstract：

Objective To explore the classification and surgical approach of magnum foramen tumor.Method A retrospective analysis was performed for 43 surgically treated patients with tumors involving the foramen magnum.According to the site of the tumor,the classification was divided to:Type Ⅰ ,located at dorsal, Ⅰ a extra - medullary, Ⅰ b intra - medullary, Ⅰ cintra - and extramedullary; Type Ⅱ,located at ventral, Ⅱ a extramedullary, Ⅱ b intramedullary.The midline approach was used in the Type Ⅰ (17cases), while the lateral or far- lateral approach for the Type Ⅱ (26 cases).Results Total excision was performed in 35(81% ).There were no mortality and no recurrence during the follow -up period.Thirtytwo patients had improvement in their neurological status, 3 cases unchanged.There were 8 cases aggravation,including newly cranial nerve deficits, hemiplegia, dyspnoea.Conclusions The preoperative classification was useful for the selection of surgical approach and evaluation of surgical outcome.The midline approach was apt to Type Ⅰ , while the lateral or far - lateral approach for the Type Ⅱ.     

320排CT血管造影对窦旁脑膜瘤显微手术的指导意义

目的 评估320排CT血管造影(CTA)对窦旁脑膜瘤手术治疗的指导价值.方法 济南军区总医院神经外科自2008年5月至2010年8月对38例上矢状窦旁脑膜瘤患者术前行320排CTA检查,观察肿瘤血管与颅脑血管、肿瘤与颅骨的关系,指导肿瘤切除术.结果 320排CTA能清楚显示脑膜瘤的形态及其与邻近大血管、颅骨的三维关系和静脉窦的开放程度,38例患者均做到显微镜下全切除,其中SimpsonⅠ级26例,Ⅱ级12例,无手术死亡.术后出现暂时性偏瘫或原偏瘫加重8例,经治疗5例恢复正常.结论 320排CTA能提供脑膜瘤与邻近血管、颅骨和矢状窦的三维空间图像,为手术入路和术中矢状窦的处理提供有用信息,在窦旁脑膜瘤术前评估中有其独特的价值.

Abstract：

Objective To evaluate the clinical value of 320-row CT angiography (CTA) in the microsurgery of parasagittal meningiomas. Methods Thirty-eight patients with parasagittal meningiomas, admitted to our hospital from May 2008 to August 2010 and confirmed by CT and MR1,were examined with the 320-row CTA to observe the relations between tumor blood vessels and brain vessels, and between the tumor and the skull. Results The 320-row CTA provided clear three-dimensional images of the meningioma and its relations with the adjacent vessels and the skull. The condition of blood flow in the parasagittal sinus was shown and the proper surgical approach to remove the neoplasm was demonstrated. Simpson graded Ⅰ and Ⅱ resection was achieved in 26 and 12 patients,respectively. All the patients recovered well without postoperative deaths. Temporary paralysis or aggravated paralysis was noted in 8 after the operation and 5 of them recovered. Conclusion The 320-row CTA, being able to provide images of the parasagittal meningioma, and demonstrating its relations with the skull, adjacent vessels and sagittal sinus, can supply the vital information to choose the proper surgical approach and provide the useful message to manage the sinus during the operation, which has a great value in preoperative evaluation of the parasagittal meningioma.     

蝶窦海绵窦脑膜瘤术后眼睑下垂相关因素及并发症分析

目的 分析蝶窦海绵窦脑膜瘤显微手术术后眼睑下垂相关因素及并发症.方法 回顾性研究首都医科大学附属北京天坛医院颅底脑干病房从1993年4月到2008年12月的49例蝶窦海绵窦脑膜瘤的治疗情况,对可能导致术后眼睑下垂的危险因素进行Logistic回归分析.结果 男41例,女38例;平均年龄52.4岁;病史平均20.9个月.最常见症状为脑神经损害,MRI发现肿瘤平均最大径为5.09 cm.30例患者采用额颞人路,14例采用额颞断颧弓人路,5例选用眶颧入路切除肿瘤.肿瘤近全切除率52%,死亡率2%.随访到39例患者,平均随访73.7个月,4例随访中死亡,生存的35例患者中,22例正常生活.多因素分析发现,术后眼睑下垂与海绵窦分级、术前KPS评分及既往手术史相关.结论 蝶窦海绵窦脑膜瘤全切困难,术后最常见并发症是动眼神经麻痹,术后眼睑下垂与海绵窦分级、术前KPS评分及既往手术史相关.术后随访发现肿瘤复发可辅助放疗.

Abstract：

Objective To study the surgical results and complications for sphenocavernous (SC)meningioma patients with special reference to postoperative ptosis.Method 49 consecutive cases of SC meningiomas operated between April 1993 and Dec 2008 in our department were reviewed.All the probable risk factors related to postoperative ptosis were studied with Logistic regression analysis.Results There were 38 female and 11 male patients ( mean age 52.4 years, range 31 ～ 74 years).The mean duration of symptoms was 20.9 months( ranging from 1 week to 108 months).Cranial nerves palsy was the most common presenting symptoms.The mean maximal diameter of tumor on MRI was 5.09 cm.Frontotemporal approach was performed in 30 cases,frontotemporal zygomatic approach in 14 cases and frontotemporal orbitozygomatic osteotomy approach in 5 cases.Subtotal resection was achieved in 52% patients.The surgical mortality was 2%.Follow -up data were available for 39 patients,with a mean follow- up of 73.7 months.Four patients died during follow - up period.Of the 35 living patients, 22 lived a normal life.Multi - factors that might influence ptosis after operation included the grading of cavernous extension, pre - operation KPS and the history of surgery for tumors.Conclusions Complete and safe resection of SC meningioma is difficult.Our experience suggests that the most common complication after SC meningioma surgery is ocular CN dysfunction.The factors relative to postoperative ptosis include the extension to cavernous sinus,pre - operation KPS and history of surgery for meningioma.Gamma knife radiosurgery could be considered as an adjuvant therapy only for recurrent tumors during follow - up period.     

侵袭性脑膜瘤的临床特点与手术治疗

目的 探讨侵袭性脑膜瘤的临床特点及手术治疗.方法 回顾性分析55例手术治疗的侵袭性脑膜瘤患者的临床资料.结果 与非侵袭性脑膜瘤相比,侵袭性脑膜瘤具有以下临床与影像学特点:(1)以局部结构侵蚀性症状为常见临床表现;(2)脑膜尾征更典型、更常见;(3)缺乏白环征或黑环征;(4)向静脉窦内生长;(5)不规则或扁平状更常见;(6)瘤周水肿更明显;(7)肿瘤钙化少见;(8)局部骨质的增生与破坏.Ⅰ级切除31例,Ⅱ级切除13例,Ⅲ～Ⅳ级切除11例,无严重手术并发症及死亡病例.结论 侵袭性脑膜瘤具有明显的临床特点,实施恰当的手术方案可获得良好的治疗效果.

Abstract：

Objective To explore the clinical features and surgical treatment of aggressive meningiomas ( AMs). Method The cilinical materials of 55 patients with AMs treated surgically were analyzed retrospectively. Results Compared with non - aggressive meningiomas, the clinical and imaging features of AMs included: (1) They were often manifested by the symptoms of invasion of local structures. (2) The dural tail sign was more frequent and typical. (3) The white or black ring - sign was often absent. (4) The tumor growed into cerebral venous sinus. (5 ) The tumor was frequently irregular or flat in shape. (6 ) The cerebral edema surrouding the tumor was more obvious. (7) The calcification of tumor was rare. (8 ) Hyperplasia and destruction of local skull bone were easy to be seen. Simpson Ⅰ resection was achieved in 31 cases, Ⅱ in 13, and Ⅲ～Ⅳ in 11. There was no severe complication and death after operation. Conclusions AMs have markable clinical features. Carrying out an appropriate operative strategy could get a good treatment effect.     

海绵窦海绵状血管瘤的影像特征和显微手术

目的 总结海绵窦海绵状血管瘤的诊断和手术治疗经验,探讨其影像特征和手术要点.方法 对2001年10月至2008年10月收治并手术切除的13例海绵窦海绵状血管瘤进行回顾性分析.病灶最大径3.5～6 0 cm,均经MRI证实和显微手术切除.结果 病变被全切除9例,大部切除3例,活检1例,无手术死亡.海绵窦神经保留情况:8例保留动眼神经;9例保留三叉神经第Ⅱ、Ⅲ支;其余均未能保留.结论 海绵窦海绵状血管瘤可以根据其MRI的特征性影像获得确诊.合适的手术人路、娴熟的显微外科技术是全切肿瘤的必备条件.海绵窦内神经的保留仍然是未能完全解决的问题.

Abstract：

Objective To analyze the imaging character and surgical therapy of cavernous hemangiomas in cavernous sinus ( CSHs) .Method From 2001 to 2008, 13 patients with CSHs were surgically treated in our department.The diameters of CSHs varied from 3.5 cm to 6.0 cm.Results All the patients were operated on with no mortality.Complete tumor removal was achieved in 9 cases, partial tumor removal in 3 cases, and biopsy in 1 case.Cranial nerve Ⅲ was preserved in 8 cases and cranial nerves V2,V3 in 9 cases.In the other cases, cranial nerves in cavernous sinus were sacrificed unavoidably.Conclusions CSHs can be diagnosed preoperatively according to MRI and can be removed successfully by experienced surgeons who are familiar with operative approaches and microsurgical technique.However,great efforts should be made to decrease postoperative cranial nerve deficits.     

显微手术治疗鞍结节脑膜瘤62例报告

目的：探讨鞍结节脑膜瘤的临床特点、手术入路及显微手术技巧。方法：回顾性分析2002年1月至2009年12月收治经显微手术治疗的62例鞍结节脑膜瘤患者的临床资料。根据肿瘤大小、主体生长方向、与周围重要结构关系等选择不同的手术入路。其中,51例鞍结节脑膜瘤经翼点入路,6例经额下入路,5例经额下翼点联合入路切除肿瘤。结果：SimpsonⅠ级和SimpsonⅡ级切除肿瘤55/62例（88.7%）,SimpsonⅢ级切除7/62例（11.3%）,无手术死亡病例。对62例患者进行随访,随访期限4～96个月,平均随访期38.6个月。47/62例（75.8%）恢复正常生活,12/62例（19.4%）可生活自理,3/62例（4.8%）日常生活需他人帮助,随访期间3/62例（4.8%）肿瘤复发,再次行手术治疗。结论：显微手术治疗鞍结节脑膜瘤疗效确切,充分的术前准备和个体化的手术入路及良好的显微外科技巧,可显著提高肿瘤全切率和减少并发症。     

鞍结节脑膜瘤显微手术治疗策略

目的探讨鞍结节脑膜瘤的显微手术切除策略。方法回顾性分析82例鞍结节脑膜瘤的临床资料,均采用显微手术切除。经额外侧入路44例,经眶-额外侧入路28例,经眶-颧-额-颞入路7例,经翼点入路3例。术中磨除前床突和视神经管顶及外侧嵴,切除侵入视神经管内的肿瘤27例;磨除鞍结节,经蝶窦切除鞍前壁肿瘤12例。结果肿瘤SimpsonⅠ、Ⅱ级切除75例(91.5%),SimpsonⅢ级切除7例(8.5%);术后视力改善和稳定151只眼(92.1%),视力恶化13只眼(7.9%)。术后出现不同程度下丘脑症状2例,术后偏瘫1例,无手术死亡病例。结论正确选择手术入路,采用熟练的显微颅底外科技术是获得良好手术效果的保证。额外侧入路能提供良好的手术空间和视野,术后视觉症状改善明显。术中打开视神经管,仔细辨别并保护蛛网膜屏障中的小血管,是保障肿瘤全切除和术后视力恢复的关键。     

鞍结节脑膜瘤的显微手术治疗

目的 探讨鞍结节脑膜瘤的手术入路及显微手术治疗效果。方法 回顾性分析2013年1月至2018年1月显微手术治疗的46例鞍结节脑膜瘤的临床资料,经单侧额下-纵裂入路19例,额外侧入路13例,翼点入路9例,眶上锁孔入路5例。结果 Simpson Ⅰ级切除32例,Ⅱ级切除9例,Ⅲ级切除5例。术后出现短暂尿崩2例,1例经眶上锁孔入路肿瘤切除术后出现脑脊液鼻漏,无死亡病例。全部病人术后随访6~50个月,平均26个月。术前28例视力障碍中,24例视力改善,2例加重,2例失明未恢复。肿瘤复发3例。结论 根据肿瘤部位、大小、生长方式,选择合适的手术入路,以及术中注意保护肿瘤比邻重要结构,是提高鞍结节脑膜瘤手术疗效、减少并发症的关键。     

显微手术治疗鞍结节脑膜瘤

目的探讨鞍结节脑膜瘤的手术入路和治疗策略.方法回顾性分析32例鞍结节脑膜瘤的临床资料,其中经单侧额下入路6例,经额外侧入路9例,经翼点入路8例,经额下-纵裂入路9例.结果肿瘤达SimpsonⅡ级切除26例,SimpsonⅢ级切除6例.失访3例,29例随访3～60个月,平均18.5个月.9例术前激素水平低下者术后均恢复正常.病人恢复正常工作和生活25例,不能独立生活4例.肿瘤复发2例.结论根据肿瘤大小和不同的生长方式选择恰当的手术入路,同时保护好鞍结节周围的重要结构,是获得良好手术效果的保证.     

前纵裂入路显微手术切除巨大鞍结节脑膜瘤

目的 探讨经前纵裂入路显微手术切除巨大鞍结节脑膜瘤的方法、适应证及疗效.方法 采用前纵裂入路切除直径>4 cm鞍结节脑膜瘤30例,并对其临床资料及随访结果进行回顾性分析.结果 手术切除结果按Simpson分级:Ⅰ级24例,Ⅱ级5例,共29例,占96.7%.术后视力改善20例,无改变6例,下降4例.尿崩或电解质紊乱8例,经保守治疗后好转,无死亡病例.结论 前纵裂入路是切除巨大鞍结节脑膜瘤良好的手术入路,暴露充分,可提高伞切除率和改善视力,并发症少.     

内镜下经鼻蝶入路鞍结节脑膜瘤切除术

目的总结内镜下经鼻蝶入路切除鞍结节脑膜瘤的方法、疗效、手术指征和并发症。方法回顾性分析6例鞍结节脑膜瘤的临床资料,均选择内镜下经鼻入路。结果 SimpsonⅠ级切除5例,SimpsonⅣ级切除1例。术后视力减退改善4例,加重1例;视野障碍改善1例,无变化4例;视力视野术后未查1例。术后并发脑脊液漏2例,暂时性垂体前叶功能减退1例,死亡1例。随访5例,时间6个月～3年,经MRI复查肿瘤均无复发。结论内镜下经鼻蝶入路是鞍结节脑膜瘤外科治疗方法之一,具有手术创伤小、手术时间短及可达SimpsonⅠ级切除的优点。但本方法并不适合所有鞍结节脑膜瘤,需有严格的手术指征。     

鞍结节脑膜瘤的临床特征及手术治疗（附21例报告）

目的探讨鞍结节脑膜瘤的临床特征及治疗策略。方法回顾性分析2003年10月2008年10月收治的21例鞍结节脑膜瘤患者的临床资料。结果21例肿瘤均全切。术后视力改善19例,无变化1例,死亡1例。结论鞍结节脑膜瘤临床表现以视力下降为主,合适的手术入路及术中对鞍结节周围重要结构的保护对改善患者的预后有重要帮助。     

鞍结节脑膜瘤的显微外科治疗(附30例报告)

目的探讨鞍结节脑膜瘤显微手术治疗效果。方法对30例行显微手术治疗的鞍结节脑膜瘤患者的临床资料及手术效果进行分析总结。结果肿瘤全切(Simpon分级Ⅰ、Ⅱ级)24例,次全切(Simpon分级Ⅳ级)4例,大部分切除2例。术中去骨瓣减压2例。手术死亡1例。术前有视力下降的26例患者中,术后早期视力改善20例,无变化4例,恶化2例。术后随访3～38个月,2例术中去骨瓣减压的患者分别于术后6个月及8个月时行颅骨缺损修补术;24例肿瘤全切病例中,3例患者有肿瘤复发,2例行二次手术,1例选择放射治疗。失访3例。结论鞍结节脑膜瘤位置深在,与周围血管神经等重要结构关系密切,但积极的显微外科手术治疗效果良好。     

Surgical management of tuberculum sellae meningiomas: involvement of the optic canal and visual outcome

OBJECTIVE: To present a large series of surgically treated tuberculum sellae meningiomas with particular regard to involvement of the optic canal and visual outcome. METHODS: A retrospective analysis was done on 53 patients (40 female) with meningiomas originating from the tuberculum sellae who underwent surgery between 1991 and 2002. The standard surgical approach consisted of pterional craniotomy. Sixteen meningiomas extended posteriorly onto the diaphragma sella, 29 anteriorly to the planum sphenoidale, and 19 to the anterior clinoid process. Thirty seven tumours involved the optic canal, three bilaterally. Follow up ranged from 6 to 108 months (mean 29.9 months). RESULTS: Total macroscopic resection was achieved in 48 patients. Median tumour size was 2.6 cm. Postoperatively, visual acuity improved in 20 patients and deteriorated in seven. Preoperative and postoperative visual acuity worsened with increasing duration of preoperative symptoms and with increasing age. Extension into the intraconal space was a negative predictor. However, tumour size did not influence visual acuity. Recurrence occurred in two cases (21 and 69 months postoperatively). Two patients died from causes unrelated to the tumour. CONCLUSIONS: In the majority of patients with tuberculum sellae meningiomas, total resection may be achieved through a pterional approach with minimal complications.     

鞍结节脑膜瘤显微外科手术入路选择与临床分析

目的探讨不同部位和大小的鞍结节脑膜瘤显微手术入路和手术结果。方法回顾分析安徽省立医院神经外科自2002年01月至2011年07月鞍结节脑膜瘤49例,采用5种不同的手术入路,采用显微外科技术手术切除。分析全切除率、手术效果和并发症发生的情况。结果经单侧额下入路18例,经冠状开颅额下入路15例,冠状开颅前纵裂入路7例,眶上锁孔入路5例,翼点或改良翼点入路4例。肿瘤切除程度按Simpson分级评估,达SimpsonII级切除者40例,III级切除者9例,肿瘤全切除率(Simpson II级)为81.6%。本组1例死亡病例,死亡原因考虑术前患者即肿瘤卒中昏迷,术后致多脏器衰竭。术前38例合并视力减退及视野缺损,术后视力较术前明显改善20例,无明显变化17例,视力加重1例。结论显微手术是治疗鞍结节脑膜瘤的主要手段,手术入路选择应根据:①肿瘤的生长方式,肿瘤的大小。②术前视力视野受累程度。③术者习惯。④手术路径最短,对脑组织损伤最小。手术疗效取决于:术前视力受累程度,病程的长短,术中对神经、血管和脑组织的保护,肿瘤全切除率等。