神经导航在经小切口切除颅内表浅肿瘤术中的应用

目的评价神经导航系统在经小切口切除颅内表浅肿瘤中的应用。方法术前对37例病人(导航组)行MRI或CT连续薄层扫描,将影像学资料输入VectorVision2神经导航系统进行三维重建,标记肿瘤后,设计最佳手术入路和头皮切口。术中在导航引导下准确定位并切除肿瘤。以同期30例常规骨瓣开颅手术的大脑半球肿瘤病人(对照组)作为对照。结果导航组均准确全切肿瘤;注册误差0.5～1.6mm,平均(1.12±0.38)mm。导航组平均手术切口长4.9cm,骨瓣面积8.26cm2,出血64.5ml;对照组平均手术切口长13.7cm,骨瓣面积16.34cm2,出血214.1ml。结论与常规手术比较,神经导航引导下经小切口切除颅内表浅肿瘤具有定位准确,创伤小,手术时间短,失血量小及并发症少等优点,值得推广应用。     

神经导航下图像融合在窦镰旁脑膜瘤切除手术中的应用

目的 探讨神经导航下影像学图像融合在窦镰旁脑膜瘤切除手术中的应用价值。方法 回顾性分析23例应用Stryker Neuro导航系统引导及影像学图像融合下手术治疗窦镰旁脑膜瘤的手术经验。结果 23例窦镰旁脑膜瘤均顺利实施导航手术,定位精确,平均注册误差(2.0±0.5)mm,全切18例,次全切除5例。术后随防3个月均未遗留严重神经功能缺损,无患者死亡。结论 在术前规划中神经导航进行影像学图像融合对于窦镰旁脑膜瘤搜索评估手术风险、选择安全的手术入路具有重要作用,清晰地显示周围重要结构及血管情况,手术创伤小,能在最大程度上保留脑功能,提高手术安全。     

神经导航多模态融合技术在窦镰旁脑膜瘤手术中的初步应用

目的探讨神经导航多模态融合技术在窦镰旁脑膜瘤显微手术中的应用价值。方法回顾性分析35例应用神经导航多模态融合技术辅助显微手术治疗的窦镰旁脑膜瘤患者的临床资料。结果 20例窦旁脑膜瘤,全切16例,次全切除4例;15例镰旁脑膜瘤均全切。术后随防3个月,均未遗留严重神经功能缺损,无患者死亡。结论应用神经导航辅助显微手术能使窦镰旁脑膜瘤定位准确可靠,清晰地显示周围重要结构,可提高手术的准确性,减少术中的盲目性,缩短手术时间,提高手术安全性。     

30例窦镰旁脑膜瘤的显微外科治疗体会

目的探讨窦镰旁脑膜瘤显微手术切除方法和疗效。方法回顾性分析30例窦镰旁脑膜瘤患者显微手术治疗的临床资料。结果术后按Simpson标准,在30例窦镰旁脑膜瘤患者中肿瘤Ⅰ级切除23例,Ⅱ～Ⅲ级切除7例,无手术死亡病例。结论熟练的显微外科技术可以有效的控制术中出血,明显提高窦镰旁脑膜瘤的全切除率,降低复发率,减少致残及病死率。     

神经导航及内镜下小骨窗治疗高血压脑出血

目的评价神经导航辅助内镜使用一次性透明鞘小骨窗治疗高血压基底节区脑出血的临床疗效。方法回顾性分析54例采用神经导航辅助内镜治疗高血压基底节区脑出血患者的临床资料。结果 54例患者手术切口长度为3~4 cm,骨窗直径2~2.5 cm,手术时间45~110分钟(平均70分钟),平均血肿清除率95%。术后6个月GOS评分:恢复良好10例,轻度残疾15例,重度残疾27例,植物生存0例,死亡2例。结论神经导航辅助内镜使用一次性透明鞘小骨窗入路治疗高血压脑出血疗效确切,其优点微创、精准、省时及预后好,经颞入路仍是直接简便的入路,因此该技术具有较高的临床应用价值。     

接触式激光刀辅助显微手术切除矢状窦镰旁脑膜瘤的临床研究

目的探讨接触式激光刀辅助显微手术切除矢状窦镰旁脑膜瘤的效果。方法收集35例经接触式激光刀辅助显微手术切除矢状窦镰旁脑膜瘤患者的临床资料,分析肿瘤的切除程度、术中出血量、保留窦壁完整程度及疗效。结果 35例患者矢状窦镰旁脑膜瘤的切除程度均达Simpson分级Ⅱ级,接触式激光刀使用过程中术野出血量平均50 ml,均保留矢状窦窦壁的完整性,术后无神经功能缺损者。结论位于矢状窦镰旁宽基底且质硬的脑膜瘤,用接触式激光刀辅助显微手术使肿瘤切除彻底,术野出血少,矢状窦保留完整,提高手术的疗效。     

单侧眶上小骨窗显微手术切除嗅沟脑膜瘤

目的推介一种经额微创的嗅沟脑膜瘤手术入路—单侧眶上小骨窗入路。方法从2000年12月到2004年12月,17例嗅沟脑膜瘤采用单侧眶上小骨窗入路切除肿瘤。肿瘤直径小于7cm 5例,小于6 cm 2例,小于5 cm 10例。单侧生长4例,对称生长10例,偏侧生长3例。临床症状以头痛(13例)、视力下降(12例)、嗅觉丧失(14例)为主。翼点入路皮肤切口,眶上缘上方形成带颞肌蒂小骨瓣(2.0~3.5 cm),电灼切断肿瘤基底,瘤内分块切除,最后分离分块切除瘤皮。结果所有病例肿瘤全部切除,其中S impsonⅠ级3例,S impsonⅡ级14例。额叶保护良好,无脑脊液漏。随访6个月到4年,未见影像学上复发。结论单侧眶上小骨窗入路能满足不同大小、生长方向嗅沟脑膜瘤切除所需操作空间。开颅快,微创。显露肿瘤基底直接。利于容貌保护。     

纵裂入路切除双侧窦镰旁脑膜瘤

目的 探讨纵裂入路显微切除双侧窦镰旁脑膜瘤的手术方法 ,分析该术式的影响因素.方法 应用纵裂入路显微切除双侧窦镰旁脑膜瘤21例,同时处理受累的矢状窦及大脑镰,并对手术的方法 及效果进行分析.结果 Simpson I级切除2例、Ⅱ级切除13例,Ⅲ级4例,Ⅳ级2例.结论 纵裂入路显微切除双侧窦镰旁脑膜瘤,手术路径短,暴露空间大,周围结构保护良好.肿瘤切除程度取决于肿瘤与矢状窦、胼周动脉、胼缘动脉、中央沟、上引流静脉等结构的关系.     

窦镰旁脑膜瘤的显微手术治疗

目的探讨窦镰旁脑膜瘤显微手术切除方法和疗效。方法回顾性分析36例窦镰旁脑膜瘤患者的临床资料。结果术后按Simpson标准,肿瘤Ⅰ级切除27例,Ⅱ级切除9例,无手术死亡病例。术后29例获得随访,时间6月～9年,其中25例恢复正常生活、工作,4例术后6月-9年因肿瘤复发而再手术,其中1例9年内因多次肿瘤复发而再手术切除达6次和行γ刀等放疗。结论熟练的显微外科技术可以有效的控制术中出血、有效保护中央沟静脉、明显提高窦镰旁脑膜瘤的全切除率、降低复发率、减少致残及死亡率。     

侵袭性脑膜瘤的诊断和治疗

目的探讨侵袭性脑膜瘤的临床特点和治疗方法。方法对手术治疗的52例侵袭性脑膜瘤患者的临床资料进行回顾性分析。肿瘤位于幕上凸面、镰窦旁、侧脑室内共44例,颅底6例,幕下2例。幕上肿瘤主要采用马蹄形瓣状开颅,幕下采用幕下旁正中切口。颅底肿瘤分别采用翼点、乙状窦后,额下入路。结果 52例患者共进行75次手术,其中1次手术34例,2次手术14例,3次手术3例,4次手术1例。手术后24例行普通放疗,4例行适形放疗,11例行γ-刀治疗。SimpsonⅠ级切除30例,Ⅱ级切除10例,Ⅲ级切除11例,Ⅳ级切除1例。出院后共有37例患者得到1个月~11年随访,7例随访到的Ⅲ级脑膜瘤全部复发。Ⅱ级脑膜瘤随访30例,其中16例患者尚未复发,14例患者复发。结论侵袭性脑膜瘤是颅内较少见肿瘤,预后较差。手术切除和手术后辅助放疗是延长患者生存期的重要手段。     

Falx Meningiomas: Surgical Results and Lessons Learned from 68 Cases

Objective

The purpose of this study was to review the characteristics of falcine meningioma retrospectively and to identify the parameters associated with tumor recurrence.

Methods

The analysis included; age, sex, extent of resection, and radiologic and pathologic findings. Falcine meningiomas were classified by location as anterior, middle, or posterior as described for parasagittal meningiomas.

Results

Of the 795 meningioma patients treated between 1990 and 2004 at the authors'' institution, 68 patients with meningiomas arising from the falx underwent craniotomies. There were 22 male and 46 female patients (1 : 2.1). Mean age was 55 years and ranged from 14 to 77 years. Locations of falcine meningioma were; the anterior third in 33 cases, middle in 20, and posterior in 15. Mean tumor volume was 42 cc and ranged from 4 to 140 cc. In 58 of the 68 patients tumors were totally removed. Additional surgery for recurrence was performed in 6 patients over 15 years. Of these 6 patients, only two patients underwent gross total tumor resection at first operation; the other four underwent subtotal tumor resection. Based on pathologic reports, the largest tumor subtype was transitional. There were four patients with a high grade tumor-three atypical and one anaplastic meningioma. Of the 68 patients, 59 achieved a good outcome (no neurological deficit or recurrence), six had temporary complications, two suffered new permanent postoperative deficits, and the remaining one died due to severe brain swelling despite postoperative intensive care. Extent of surgical resection was found to be significantly related to tumor recurrence.

Conclusion

Falcine meningioma accounted for 8.5% of intracranial meningiomas and the transitional meningioma was the most common subtype of falcine meningioma. Gross total resection of tumor was the single most important predictor of an improved surgical outcome.     

侵及上矢状窦大型和巨大型脑膜瘤的显微外科治疗

目的探讨显微外科手术切除侵及上矢状窦的大型和巨大型脑膜瘤的方法和效果。方法回顾性分析2009年5月至2019年5月北京大学第三医院神经外科收治的154例侵及上矢状窦的大型和巨大型脑膜瘤[肿瘤直径为(5.5±1.2)cm(4~8 cm)]患者的临床资料。采用翻向颞侧的"马蹄形"切口,沿中线旁和纵裂进行显微外科手术切除肿瘤。采用Simpson分级评估肿瘤的切除程度。临床随访结果以Karnofsky功能状态评分(KPS)评估,行影像学随访评估肿瘤有无复发。结果154例患者中,达到SimpsonⅠ级切除112例(72.7%),Ⅱ级切除42例(27.3%)。病理学检查均证实为脑膜瘤(世界卫生组织分级为Ⅰ级)。手术时间为30~210 min,中位时间为60 min;术后住院时间为(7.2±1.1)d(5~10 d)。术后无感染、脑脊液漏,无死亡病例,无永久性神经功能障碍加重。154例患者术后随访(63.5±0.7)个月(3~123个月),KPS为(93.6±0.3)分(80~100分);14例患者(9.1%)的肿瘤复发,其中SimpsonⅠ级切除组7例,SimpsonⅡ级切除组7例。两组复发率的差异有统计学意义(χ^2=4.01,P<0.05)。结论对于侵及上矢状窦的大型和巨大型脑膜瘤,通过显微外科手术大多可达到SimpsonⅠ级切除,有利于降低术后的复发率。     

上矢状窦旁脑膜瘤术后复发相关因素分析

目的探讨影响上矢状窦旁脑膜瘤术后复发的相关因素。方法回顾性分析97例上矢状窦旁脑膜瘤临床资料,采用非条件Logistic回归对性别、年龄、肿瘤部位、术前有无癫疒间、病理分级、肿瘤大小、手术切除程度与肿瘤复发是否相关进行分析。结果脑膜瘤术后复发16例（16.5%）。Logistic回归显示肿瘤大小（P=0.004）、手术切除程度（P=0.008）及病理级别（P=0.000）与肿瘤复发相关,具有统计学意义。结论肿瘤体积大、手术切除程度低及病理级别高是上矢状窦旁脑膜瘤术后复发的重要因素。     

大脑镰及矢状窦旁脑膜瘤的显微手术治疗

目的探讨大脑镰及矢状窦旁脑膜瘤显微手术方法和疗效。方法回顾性分析34例大脑镰及矢状窦旁脑膜瘤患者的临床资料,34例患者均行显微手术治疗。结果脑膜瘤切除程度按Simpson分级:Ⅰ级切除26例,Ⅱ~Ⅲ级切除8例。术后随访0.5~5年,22例患者感觉或运动障碍均有不同程度的恢复;8例癫痫患者中6例癫痫未再发作;复发1例,再次行手术治疗。结论采用显微外科技术,有效保护重要引流静脉、侧副静脉及静脉窦,尽可能全切除或次全切除肿瘤,是提高大脑镰及矢状窦脑膜瘤手术疗效的重要因素。     

Surgical treatment of parasagittal and falx meningiomas

BACKGROUND AND PURPOSE: We present our experience with surgery of parasagittal and falx meningiomas with special consideration of surgical outcome and risk of recurrence. MATERIAL AND METHODS: A series of 87 consecutive patients surgically treated for parasagittal and falx meningiomas is reported. 50 patients had parasagittal meningiomas and a further 37 had falx meningiomas. Meningioma invaded the superior sagittal sinus in 21 cases. According to Simpson's scale, 25 procedures were Grade I resection, 55 were Grade II resection and 7 were Grade IV resection. Among 21 patients with parasagittal meningiomas invading the sagittal sinus, radical resection of the tumour and invaded part of sinus was made in 9 cases. RESULTS: Seven patients were severely disabled and 4 patients died after the surgery whereas 76 patients had satisfactory outcome on discharge. At the time of analysis, 14 patients had shown evidence of recurrence. Male gender, partial removal of meningioma (Simpson Grade IV) and bilateral falx meningioma had a statistically significant influence on recurrence. There were no tumour recurrences following radical resection of the tumour and invaded part of sinus, but two postoperative deaths due to haemodynamic complications were noted. In the other 12 patients, meningiomas were removed but sinus infiltration was left in place; the postoperative period was uneventful but the rate of clinically important regrowth in this group of patients was 25% in long-term follow-up. CONCLUSIONS: Rate of recurrence of parasagittal and falx meningioma significantly increases in cases of non-radical resection of tumour. Aggressive surgical treatment presents several hazards and carries an increased risk of unsatisfactory outcome; the risk of recurrence, however, is significantly decreased.     

CT血管造影结合导航技术在神经外科手术中的应用

目的评价CT血管造影（CTA）结合导航技术在神经外科手术的应用价值。方法回顾性分析16例通过CTA结合导航技术进行神经外科手术的病人资料,其中脑膜瘤9例,胶质瘤4例,脑动静脉畸形2例,上皮样血管内皮细胞瘤1例。术前CTA重建颅内病灶、周围血管、脑组织及颅骨图像,CTA采集的图像与Brian-lab导航系统融合,设计手术入路,术中实时指导手术。结果脑膜瘤达SimpsonⅠ级切除2例,Ⅱ级切除7例。胶质瘤、脑动静脉畸形和上皮样血管内皮细胞瘤均镜下全切除。结论 CTA结合导航技术能提供无创、准确的神经影像信息,指导颅内病灶切除,同时保护脑血管及脑组织,对神经外科手术有指导意义。     

The retrosigmoid approach to petroclival meningioma surgery

Petroclival meningiomas are technically challenging lesions. The authors retrospectively analyzed their experience between 2000 and 2010 in 82 patients with petroclival meningioma to evaluate changes in management strategy. A total of 42 patients (51%) were treated via the retrosigmoid approach. The patients received postoperative neurological and neuroradiological follow-up. The maximum diameter of the tumors ranged from 1.5 cm to 6.5 cm (mean, 3.8 cm). Gross total resection (Simpson Grade II) was achieved in 27 patients (64%), subtotal resection (Simpson Grade III) in 11 (26%), and partial removal (Simpson Grade IV) in four (9.5%). Ten patients (24%) had new neurological deficits or worsening of pre-existing deficits. One patient (2%) died because of brainstem dysfunction after surgery. The retrosigmoid approach is suitable for treatment of selected petroclival meningioma if the main part of the tumor is located in the posterior fossa in the cerebellopontine angle and the low clivus, and only a minor part of the tumor extends to the posterior wall of the cavernous sinus. This approach provides a low degree of surgical difficulty and a low complication rate.     

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.     

显微镜下锁孔手术治疗56例颅内小脑膜瘤的疗效分析

目的探讨小脑膜瘤的治疗策略。方法回顾性分析2012年1月至2014年12月采用显微镜下经锁孔手术治疗的56例小脑膜瘤(直径1~3 cm)患者的临床资料并随访观察疗效。结果 56例患者中,男性15例、女性41例,年龄平均(52±10)岁。肿瘤位于大脑半球凸面35例,矢状窦旁4例,大脑镰旁1例,小脑半球凸面2例,前颅底3例,鞍区6例,中颅底2例,桥小脑角3例。所有肿瘤采用锁孔手术入路,肿瘤全切除,术后出现不良反应2例(3.57%)。42例获得随访,随访时间平均30个月,均未发现肿瘤复发,无永久性神经功能障碍。结论锁孔手术治疗颅内小脑膜瘤安全有效,支持对于小脑膜瘤应该早期手术治疗的观点。     

大脑镰及矢状窦旁脑膜瘤显微手术治疗的研究

目的探讨大脑镰及矢状窦旁脑膜瘤显微手术的方法及效果。方法回顾性分析47例大脑镰及矢状窦旁脑膜瘤患者的临床资料,术前影像学检查显示肿瘤位于矢状窦前1/3者27例,中1/3者11例,后1/3者9例,肿瘤最大径4~8 cm,47例患者均行显微手术治疗。结果按照切除程度划分,SimpsonⅠ级切除25例,Ⅱ级切除17例,Ⅲ级切除5例。随访时间6~49个月,SimpsonⅠ级切除的25例患者均无复发;22例SimpsonⅡ~Ⅲ级切除患者中,共有3例患者复发,均再次手术治疗。无手术死亡病例。结论术中对回流静脉、侧支静脉及静脉窦的保护,尽可能全切除或次全切除肿瘤,可以有效提高大脑镰及矢状窦旁脑膜瘤显微手术治疗的效果。