显微手术切除脑中央区双侧镰旁巨大脑膜瘤

目的 探讨显微外科技术在脑中央区双侧镰旁巨大脑膜瘤手术中的应用.方法 采用跨中线骨瓣、条状硬脑膜瓣、向对侧牵引上矢状窦和经单侧纵裂切除双侧肿瘤等显微手术技术,切除16例脑中央区双侧镰旁巨大脑膜瘤.结果 肿瘤均为Simpson I级切除,术后症状较术前改善13例,与术前相同3例,无手术死亡;术后随访6个月-5年,全部患者均未见肿瘤复发.结论 应用显微外科技术能够较好地避免过度牵拉脑叶,减少功能区脑皮层和重要回流静脉的损伤,消除了上矢状窦对大脑镰的"屋檐效应",有利于肿瘤的暴露和完全切除.

Abstract：

Objective To investigate microsurgical techniques in bilateral falcine meningiomas of central gyrus region surgery. Methods Sixteen patients with bilateral falcine meningiomas in central gyrus region were treateded with a series of microsurgical techniques, including midline - crossing craniotomy,dural cut in a strip fashion with a flap based on the superior sagittal sinus, retraction of the superior sagittal sinus toward the opposite side and an ipsilateral interhemispheric fissure approach. The clinical data and prognosis was summarized. Results Simpson I grade removal was achieved in all patients. The neurological functions were improved in 13 cases, unchanged in 3 cases postoperatively. There was no postoperative death. The follow up period of patients ranged from 6 to 60 months and no tumor recurrence was observed. Conclusion Application of minimally microsurgical techniques can be better to avoid over -stretch the brain leaves, reduce significant damage to eloquent cerebral cortex as well as venous reflux,and eliminate the "eaves effect" of the superior sagittal sinus to the falx in favor of exposure and complete resection of tumor.     

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.     

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.     

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.     

Midkine expression in 52 human meningiomas

BACKGROUND： Several studies have shown that midkine directly participates in tumor cell growth and invasion, as well as the regulation of angiogenesis. OBJECTIVE： To investigate midkine expression in meningioma tissue in relation to angiogenesis, invasion, peritumoral edema, and clinicopathology. DESIGN, TIME AND SETTING： The present clinical, case-controlled, neuropathological study was performed at the Laboratory of Molecular Organism, People＇s Hospital of Deyang City between May 2007 and April 2008. MATERIALS： Fifty-two meningioma tissues were classified by WHO tumor classification of the central nervous system, comprising 40 grade Ⅰ meningioma, five grade Ⅱ meningioma, and seven grade Ⅲ meningioma. Ten normal, human cerebral maters were selected from cerebral trauma patients. METHODS： Midkine protein expression and mean microvessel density were detected using immunohistochemical techniques. Simultaneously, all data were statistically analyzed. MAIN OUTCOME MEASURES： Midkine expression and microvessel density in meningiomas and normal cerebral maters. RESULTS： The positive midkine expression rate was 64% in the meningioma tissues. However, midkine expression was not detected in normal cerebral mater tissue. The mean microvessel density was 82.0 ± 22.7 in the meningiomas, and 25.8± 6.2 in the normal cerebral mater tissues. There was significant difference in midkine expression and mean microvessel density between meningioma tissues and human cerebral maters （P 〈 0.05）. Midkine expression positively correlated with microvessel density （r = 0.756, P 〈 0.05）. Midkine expression did not correlate to patient age, gender, or tumor size, location, and shape （P 〉 0.05）. However, it closely correlated with patient clinical condition, pathological grade, invasion, and peritumoral edema （r = 0.3785,0.741 2,0.6518, 0.614 2, P 〈 0.05）. CONCLUSION： Midkine protein was overexpressed in meningiomas and correlated to tumor angiogenesis, invasion, pefitumoral edema, and clinicopa     

Treatment for arteriovenous malformation of the brain——Comparison between microsurgery and gamma knife

BACKGROUND: Microsurgery and gamma knife are the mainly ways to treat arteriovenous malformation of brain in grade Spetzler-Martin Ⅰ–Ⅲ; however, therapeutic effects of them need to be further studied. OBJECTIVE: To compare the therapeutic effects between microsurgery and gamma knife on the treatment of arteriovenous malformation of brain in grade Spetzler-Martin Ⅰ–Ⅲ. DESIGN: Retrospective analysis. SETTING: Department of Neurosurgery, the Third Hospital Affiliated to Sun Yat-sen University; Guangdong Microinvasion Center. PARTICIPANTS: A total of 86 patients with arteriovenous malformation of the brain were selected from the Department of Neurosurgery, the Third Hospital Affiliated to Sun Yat-sen University and Guangdong Microinvasion Center from January 1997 to February 2007. After DSA, CT and/or MRI examinations, patients were evaluated in grade Spetzler-Martin Ⅰ–Ⅲ. All patients were divided into microsurgery group (n = 34) and gamma knife group (n =52). There were 22 males and 12 females in the microsurgery group and their mean age was 26 years, while there were 34 males and 18 females in the gamma knife group and their mean age was 28 years. The grade of Spetzler-Martin was comparable in the two groups. All their relatives provided the confirmed consent and the study was allowed by ethics committee of our hospital. METHODS: Under complete anesthesia, patients were given microsurgery and the operative approach was chosen based on diseased regions. Firstly, feeding artery was blocked; secondly, it was separated along band of gliosis between malformation vessel mass and brain tissue; finally, draining vein was cut off and malformation vessel mass was resected. On the other hand, patients in the gamma knife group received Leksell-2300B gamma knife treatment. Leksell-G stereotaxis headframe was installed; GE1.5TMR scanning device was used for localization; r-Plan5.2 workstation was used for target design and dosage program; Leksell B gamma knife was used during the whole operative procedure. The target was 1–4 and peripheral dosage was 12–28 Gy. At 0.5, 1 and 2 years after operation, angiography was used to detect vascular occlusion in the two groups. Meanwhile, focal hemorrhage and new neurological function defect (including hemiplegic paralysis, language disorder, cerebellar function disorder, increasing frequency of epilepsy, etc.) were also observed. MAIN OUTCOME MEASURES: Rate of vascular occlusion, focal hemorrhage and neurological function defect at different time points after operation. RESULTS: All 86 patients were involved in the final analysis. Vascular nest of patients in the microsurgery group disappeared completely; while, two patients (6%, 2/34) had new neurological function defect but did not have rehaemorrhagia and death after operation. On the other hand, vascular nest of 43 patients (83%, 43/52) in the gamma knife group disappeared completely, and 8 (15%, 8/52) had new neurological function defect. There was significant difference between the two groups (χ2=2.63, P < 0.05). Six patients (12%, 6/52) in the gamma knife group had rehaemorrhagia after operation, and one (2%, 1/52) died. CONCLUSION: Both microsurgery and gamma knife have great effects on the treatment of arteriovenous malformation of brain in grade Spetzler-Martin Ⅰ–Ⅲ; however, the therapeutic effects of microsurgery are superior to those of gamma knife.     

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.     

Comparison of indocyanine green fluorescent angiography to digital subtraction angiography in brain arteriovenous malformation surgery

BACKGROUND The potential utility of intraoperative microscope-integrated indocyanine green （ICG） fluorescence angiography in the surgery of brain arteriovenous malformations （ AVMs ） and evaluation of the completeness of resection is debatable. Postoperative catheter angiography is considered the gold standard. We evaluated the value of ICG and intraoperative catheter angiography in this setting. METHODS Between January 2009 and July 2013, 37 patients with brain AVMs underwent surgical resection of their vascularlesions. ICG videoangiography and an intraoperative catheter angiography were performed in 32 cases, and a routine postoperative angiogram was performed within 48 h to 2 weeks after surgery. The usefulness of ICG findings and the ability to confirm total resection and to identify residual nidus or persistent shunt were assessed and compared to intraoperative and postoperative digital subtraction angiography, respectively. RESULTS There were 7 grade 1, 11 grade 2, 11 grade 3 and 3 grade 4 Spetzler-Martin classification AVMs. ICG angiography helped to distinguish AVM vessels in 26 patients. In 31 patients, it demonstrated that there was no residual shunting. In one patient, a residual AVM was identified and further resected. Intraoperative catheter angiography detected two additional small residuals that were missed by ICG angiography, both deep in the surgical cavity. Further resection of the AVM was performed, and total resection was confirmed by a repeat intraoperative angiogram. Postoperative angiography in a patient with a grade 4 lesion revealed one additional small deep residual AVM nidus with persistent late shunting missed on both ICG and intraoperative angiography. Overall ICG angiography missed three out of four residual AVMs after initial resection, while the intraoperative angiogram missed one. CONCLUSION Although ICG angiography is a helpful adjunct in the surgery of some brain AVMs, it＇s yield in detecting residual AVM nidus or shunt is low, especially for deep-seated lesions and hi     

Effect of baclofen combined with neural facilitation technique on the reduction of muscular spasm in patients with spinal cord injury

BACKGROUND: Recent researches have demonstrated that baclofen is a commonly central anti-spasm drug. In addition, neural facilitation technique based on nerve development and neurophysiology is widely used for rehabilitation training of motor disorder after central nerve injury. However, whether baclofen combining with neural facilitation technique can relieve muscular spasm after spinal cord injury needs further studies. OBJECTIVE: To observe the effect of baclofen combining with neural facilitation technique on decreasing muscular tension in two lower extremities after spinal cord injury. DESIGN: Randomized controlled study. SETTING: Departments of Rehabilitation and Orthopaedics, the Third Affiliated Hospital of Guangzhou Medical College. PARTICIPANTS: A total of 28 patients with spinal cord injury, including 17 males and 11 females, whose age ranged from 31 to 71 years, were selected from Departments of Rehabilitation and Orthopaedics, the Third Affiliated Hospital of Guangzhou Medical College from March 2005 to September 2006. The illness course ranged from 22 to 54 days and the mean course was (38±8) days. All patients were diagnosed as the first onset and the increase of extensor muscular tension in two lower extremities after thoracic vertebra injury by using spine MR or CT examination. Informed consents were obtained from all the patients. METHODS: All 28 patients who had upper motor neuronal paralysis in two lower extremities after spinal cord injury in thoracic vertebra region were randomly divided into treatment group and control group with 14 cases in each group. Patients in both groups received routine therapy, while those in the treatment group were treated with oral baclofen (the beginning dosage: 5 mg/time; three times per day, 5 mg was increased every three days; the maximal dosage was 60 mg/day; 6 weeks in total) (made in Weicai Pharmaceutical Co., Ltd.; tablet; batch number: HC20040029) combining with neural facilitation technique, which accorded to Rood technique (slight joint extrusion, slow and persistent stretch, etc.), Brunnstrom technique (non-symmetric cervical reflex: head turning to one side promoting contralateral flexuosity in both upper and lower extremities) and Bobath technique (reflective inhibition, such as reducing supine position; increasing lateral recumbent position, rolling in bed and posture transfer; controlling key sites; 6 weeks in total). MAIN OUTCOME MEASURES: At 6 weeks after treatment, modified Ashworth grading method and Barthel Index were used to detect extensor muscular tension in two lower extremities and activities of daily living (ADL) of patients in both groups. RESULTS: ① Grade of muscular tension in two lower extremities: At 6 weeks after treatment, muscular tension in the treatment group was classified into gradeⅠ (n =12), gradeⅡ (n =2) and grade Ⅲ(n =0), which was markedly improved as compared with that in the control group [grade Ⅰ (n =6), grade Ⅱ (n =4) and grade Ⅲ (n =4)]. In addition, there was significant difference between the two groups (P < 0.05). ② ADL ability: Barthel Index of patients with complete and incomplete spinal cord injury in the treatment group was higher than that in the control group at 6 weeks after treatment, and there was significant difference between them (P < 0.05). CONCLUSION: Baclofen combining with neural facilitation technique can not only remarkably relieve muscular tension of upper motor neuronal paralysis after spinal cord injury, but also obviously accelerate recoveries of motor functional and ADL ability.     

不同病理类型脑膜瘤对周围组织侵袭性的研究

目的 研究不同病理类型脑膜瘤对周围组织的侵袭性.方法 分析我院2009年4月至2010年6月行手术治疗达Simposon Ⅰ级切除的脑膜瘤患者手术标本124例;病理类型参照WHO2007年版中枢神经系统肿瘤分型,通过病理连续切片分析肿瘤对周围组织的侵袭性.结果 脑膜瘤侵袭性主要表现为纵向和横向侵袭.良性脑膜瘤对基底硬膜侵袭常见,但对骨质和脑组织侵袭少见;非良性脑膜瘤对硬膜、骨质以及脑组织均有明显的侵袭;部分良性脑膜瘤对周边硬膜存在横向侵袭,范围绝大多数在2 cm以内;绝大多数非良性脑膜瘤对周边硬膜存在明显的侵袭,范围在2 cm以外.结论 脑膜瘤不同的病理亚型对周围组织侵袭有所不同.强调术中冰冻病理以及针对不同病理亚型选择术中着重处理点,对降低脑膜瘤术后复发率有重要意义.

Abstract：

Objective To explore the invasion of different types of meningeoma to the surrounding tissue. Method The specimen from 124 patients with meningeomas, who underwent surgery in Southern Hospital from April 2009 to June 2010 were used to analyze the invasion of different types of meningeomas to the surrounding tissue. All the tumor were resected in the standard of Simposon I. We referred to WHO 2007 edition to indentify the type of pathology. Results The invasion included longitudinal type and transversal type. The invasion in the basal dura mater was commonly seen in the benign meningioma, while the invasion was rarely seen in the bone and brain. As to the non - benign meningioma, invasion was commonly seen in dural mater, bone and brain. Some benign meningioma could invase the peripheral dural mater within the range of 2 cm, while most non - benign meningioma invased the peripheral dural mater beyond the range of 2 cm. Conclusions Different types of the 124 cases of meningioma own different characters on the invasion. The frozen pathological examination during the operation and special treatment on the key point of the surrounding tissue may decrease the relapse rate after operation.     

中央区巨大脑膜瘤的显微手术治疗

目的 探讨中央区巨大脑膜瘤的围手术期管理及手术注意事项。方法 回顾性分析2008年1月至2016年1月收治的18例中央沟区巨大脑膜瘤的临床资料，总结手术治疗经验。结果 18例中，Simpson分级Ｉ级切除13例，Ⅱ级切除3例，Ⅲ级切除2例。术后出现肢体肌力下降8例，癫痫发作6例，脑水肿加重行去骨瓣减压术1例。术后随访1年，肢体肌力恢复正常16例，下肢肌力Ⅳ级1例，长期昏迷1例；无癫痫发作病例。术后3年复发1例，术后5年复发1例。结论 对于中央区巨大脑膜瘤，术前需仔细评估，充分了解肿瘤的血供、性质、静脉引流情况，必要时行DSA检查及栓塞部分供血动脉；术中通过合适的暴露范围，留置腰大池引流管引流脑脊液，减少脑组织牵拉，分块切除肿瘤，保护引流静脉，争取全切肿瘤；术后合理地预防癫痫，维持血压稳定，尽早进行康复治疗，减少并发症，提高治疗效果。     

椎管内脊膜瘤显微手术切除

目的 探讨椎管内脊膜瘤的显微外科手术治疗经验与技巧,以提高其临床疗效.方法 回顾性分析38例椎管内脊膜瘤病人的临床表现、影像学资料及随访情况,均行显微外科手术切除肿瘤.结果 术后病理检查均确诊为脊膜瘤.按Simpson切除分级:I级32例,II级5例,I、II级切除均为全切除,共37例(97.4％);Ⅲ级切除(部分切除...     

高龄患者中央区巨大脑膜瘤的显微外科治疗

目的探讨高龄患者中央区巨大脑膜瘤的病史特点、治疗方法、手术决策、围手术期处理及疗效。方法回顾性分析70岁以上运动功能区脑膜瘤45例患者的临床表现和病史特点,分析治疗方法的选择、手术决策、围手术期及术后处理与疗效的关系。结果切除范围根据改良Simpson分级,Ⅰ级切除者32例,Ⅱ级切除者13例。术后患者全部存活,出现肺部感染5例,心律不齐6例,消化道出血2例,继发性脑梗塞3例,迟发性颅内血肿2例。术后随访3月~3年,均未见复发,运动功能较术前均有明显改善,恢复正常行走能力,有5例出现记忆力下降。结论高龄患者中央区巨大脑膜瘤与矢状窦、中央沟静脉、外侧裂血管及重要神经结构关系紧密,采用显微神经外科技术,中央区巨大脑膜瘤的高龄患者可取得不错的疗效,但术后易出现各种并发症。     

经额底前纵裂入路显微手术切除巨大型嗅沟脑膜瘤

目的 探讨经额底前纵裂入路显微手术切除巨大型嗅沟脑膜瘤的手术方法及疗效。方法 回顾性分析2018年2月至2020年2月经额底前纵裂入路显微手术切除的10例巨大型嗅沟脑膜瘤的临床资料。结果 按Simpson手术切除标准分级:Simpson分级Ⅰ级切除1例,Ⅱ级8例,Ⅲ级1例。无手术死亡病例,术后无颅内感染及癫痫等并发症。术后病理检查确诊为良性脑膜瘤。术后随访8~30个月,未见肿瘤复发或病情加重病例。结论 经额底前纵裂入路切除巨大型嗅沟脑膜瘤,效果良好。     

嗅沟脑膜瘤的手术策略

目的 探讨嗅沟脑膜瘤的手术治疗策略. 方法 回顾性分析广州医学院第二附属医院神经外科自2003年1月至2008年12月收治的22例嗅沟脑膜瘤患者的临床资料和手术效果. 结果本组病例中冠状开颅双侧额下入路12例,冠状开颅单侧额下入路3例,翼点入路4例,眶上锁孔入路3例.Simpson Ⅰ级切除13例,SimpsonⅡ级切除7例,SimpsonⅢ级切除2例.随访16例,时间5个月～5年,均行头颅MRI检查,未见肿瘤复发. 结论 嗅沟脑膜瘤的手术人路应根据肿瘤的大小和生长部位来选择,手术者要结合自己的熟练程度灵活掌握和运用.     

大脑镰旁脑膜瘤显微外科手术治疗

目的探讨大脑镰旁脑膜瘤的手术方法和技巧。方法对16例经手术治疗的大脑镰旁脑膜瘤的临床治疗进行回顾性分析。结果手术全切肿瘤13例,其中SimpsonI级切除9例,SimpsonlI级切除4例,其余3例SimpsonIII级切除。术后随访6—72月,2例复发,无手术死亡。结论大脑镰旁脑膜瘤手术治疗力争达到全切除,有效地控制术中出血、保护并妥善处理好重要回流静脉是确保手术成功的关键。     

鞍区脑膜瘤的显微手术治疗

目的 探讨鞍区脑膜瘤显微手术的治疗效果.方法 对62例行显微手术治疗的鞍区脑膜瘤患者的临床资料及手术效果进行分析总结.结果 42例全切(Simpson Ⅰ、Ⅱ),16例次全切(Simpson Ⅲ),4例大部分切除,术中去骨瓣减压4例,无手术死亡.术后早期出现同侧动眼神经瘫12例,滑车和外展神经功能障碍8例,对侧肢体轻瘫4例.肿瘤未全切的20例中有11例术后行放射治疗.随访3-38个月,动眼神经瘫恢复5例,滑车和外展神经功能恢复3例,肢体活动障碍恢复2例.全切病例中,10例有肿瘤复发,4例行二次手术,6例行放射治疗.失访4例.结论 鞍区脑膜瘤显微手术的治疗效果良好.     

68例前颅底脑膜瘤的显微外科治疗

目的 探讨提高前颅底脑膜瘤全切率、降低死亡率和并发症的显微外科治疗策略.方法 分析显微手术治疗的68例前颅底脑膜瘤的影像学资料、手术入路、手术技巧及疗效等资料,总结经验教训.结果 肿瘤切除达到Simpson Ⅰ级或Ⅱ级58例（85.29％）,次全切除8例,部分切除2例;病理检查均证实为脑膜瘤;术后主要原有症状较术前改善64例（94.12％）,无改善4例,术后早期出现并发症6例,死亡1例;随访6个月至5年,2例复发,二次手术切除.结论 通过充分的术前准备,选择恰当的手术入路,依靠娴熟的显微外科手术技巧处理好手术细节,严密监测术中术后并发症,积极谨慎的切除前颅底脑膜瘤可以取得满意疗效.     

显微手术治疗窦镰旁脑膜瘤的疗效分析

目的 探讨显微手术治疗窦镰旁脑膜瘤的手术技巧和临床疗效。方法 回顾性分析2019年5月至2021年7月显微手术治疗的42例窦镰旁脑膜瘤的临床资料。结果 术中发现肿瘤突入窦腔内4例,与窦壁外层紧密联系8例,位于窦镰旁30例。Simpson分级Ⅰ级25例,Ⅱ级15例,Ⅲ级2例。无手术死亡病例。术后随访3～12个月,未见肿瘤复发。结论 窦镰旁脑膜瘤周围组织结构复杂,手术风险高。制定合理的手术计划、术中进行精细操作,有助于减少并发症,提高手术疗效。     

鞍结节脑膜瘤的显微手术治疗

目的 探讨鞍结节脑膜瘤的显微手术治疗方法及其效果。方法 回顾性分析2007年1月至2013年7月显微手术治疗的45例鞍结节脑膜瘤患者的临床治疗,采用单侧额下入路22例,纵裂入路5例,翼点或扩大翼点入路15例,翼点及额下联合入路3例。结果 肿瘤全切除程度:Simpson分级Ⅰ级23例,Ⅱ级14例,Ⅲ级5例,Ⅳ级3例;肿瘤全切除率达82.2%。术前合并不同程度视力障碍的37例患者中,术后视力较术前好转27例,无明显变化6例,恶化4例;视力改善率73.0%。结论 鞍结节脑膜瘤周围毗邻重要结构,显微手术是其的主要治疗方法;手术时应根据肿瘤大小、生长方式、视力受损程度及术者习惯等选择不同的入路;熟悉的显微解剖知识、娴熟的显微外科技巧是手术成功的关键。