手术治疗岩斜区脑膜瘤的策略研究

目的:探讨岩斜区脑膜瘤的手术治疗策略。方法:回顾总结2007年1月至2012年6月的32例岩斜区脑膜瘤患者的临床资料、手术方式、预后及随访情况。其中颞下经小脑幕入路13例,枕下乙状窦入路19例。结果:肿瘤全切除(gross total resection,GTR)18例;近全切除(near total resection,NTR)8例;次全切除(subtotal resection,STR)(包括海绵窦区残留4例)6例;围手术期死亡1例。术后并发症主要为脑干梗塞12例(GTR组10例,NTR组2例);迟发脑内血肿18例(GTR组8例,NTR组6例,STR组4例);脑脊液漏9例(GTR组5例,NTR组2例,STR组2例)。各组并发症率为GTR组15例(83.3%);NTR组6例(75.0%);STR组4例(66.7%)。术后神经功能障碍恶化23例(71.9%),其中原有症状加重9例,新增症状者14例;神经功能障碍稳定及好转9例(28.1%)。其中GTR组15例(88.9%);NTR组5例(62.5%);STR组2例(33.3%),GTR组和非全切除组(NTR组和STR组)比较差异有统计学意义(χ2=3.94,P<0.05)。结论:追求全切除的手术策略可能增加并发症,恶化神经功能障碍,从而降低生存质量。因此手术治疗策略的选择需兼顾肿瘤全切率、术后生存质量、复发率三者之间的平衡。     

岩-斜区脑膜瘤的外科手术治疗体会

岩-斜区脑膜瘤位置很深,与脑干腹侧面Ⅲ～Ⅻ对颅神经、椎-基底动脉、上颈髓关系密切,脑膜瘤生物学特性决定了当临床出现症状、得出诊断时,往往体积较大,与周围重要结构粘连包裹,手术风险高,致残率和死亡率高.目的 提高岩斜区脑膜瘤的手术效果.方法 回顾性分析我院自1999年1月至2001年1月连续收治的16例岩斜区脑膜瘤.6例肿瘤大于4.0cm.采用了经颞下-小脑幕、颞下-乙状窦前、颞下-迷路、枕下-极外侧入路.结果 肿瘤全切除10例,近全切2例,小部分切除1例.结论 影响手术预后的最主要因素是小脑前下动脉、小脑上动脉和小脑后下动脉及其供应脑干的穿通支被肿瘤包裹及脑干受累情况.     

岩斜区脑膜瘤的显微外科治疗

目的：探讨显微手术切除岩斜区脑膜瘤的手术方法及术后疗效，总结临床治疗经验。方法：通过回顾分析我科1997年8月～2006年3月经显微切除19例岩斜区脑膜瘤的临床资料，主要采用岩骨乙状窦前入路、颞下经小脑幕入路、乙状窦后入路3种入路。结果：肿瘤全切除12例（63．2％），5例次全切，2例大部分切除，均无严重并发症发生。结论：术前充分准备、选择合适的手术入路和娴熟显微外科技术可以提高岩斜坡区脑膜瘤的切除率，减少并发症的发生，降低病死率。     

岩斜部脑膜瘤手术策略——57例临床资料分析

目的：评估岩斜部脑膜瘤手术治疗中引起不良临床后果的可能危险因素,探求平衡于良好术后生存状态与低复发进展之间的理想手术策略。 方法与对象：回顾性分析57例2002至2006年间在我院接受手术治疗的岩斜部脑膜瘤患者临床资料。预后因素分析内容包括术后神经功能障碍,改良Rankin评分及复发率。通过单因素回归分析探求可能的危险因素。平均随访时间34月（10-67月）。 结果：58%患者获得手术全切。一例患者因术后颅内出血死亡。在随访评估时,67%患者术后出现新增神经功能障碍,同时26%患者改良Rankin评分升高。24例患者出现术后并发症。12.3%患者发生影像学证实肿瘤复发,平均复发时间为42个月。19例术后残留或复发患者在接受放射外科治疗后肿瘤未进一步进展。肿瘤粘连程度、血供及与周围血管神经包绕关系与术后改良Rankin评分升高密切相关（p=0.0002;p=0.0051;p=0.0009）,并且肿瘤的粘连程度能显著影响肿瘤的切除范围（p=0.0029）。术后出现新增颅神经功能障碍的主要因素是肿瘤与周围神经血管的包绕关系（p=0.0004）。 结论：术中发现的肿瘤的各种性质,尤其是肿瘤的粘连程度对界定术后出现神经功能障碍及不良改良Rankin评分人群有重要预测作用。术前对患者的临床资料做出仔细个体化评估外加相对保守的手术方式对改善患者生活质量有一定帮助。     

大型、巨大型岩斜区脑膜瘤的手术策略*

目的:探讨大型、巨大型岩斜区脑膜瘤的手术效果,以提高和改善预后.方法:回顾性分析新疆医科大学第一附属医院神经外科2000年1月-2011年6月显微手术切除的32例岩斜区脑膜瘤的临床资料.结果:32例岩斜区脑膜瘤,肿瘤全切除12例,次全切除12例,大部分切除8例.全切除术后的近期和远期并发症最高(P<0.05),而次全切除与大部分切除相比,其术后的近期和远期并发症差异比较无统计学意义(P>0.05).结论:对于大型、巨大型岩斜区脑膜瘤,次全切除是一个合理的手术策略.     

大型岩斜脑膜瘤的显微手术治疗

目的　对 12例大型岩斜脑膜瘤行乙状窦前入路的显微手术治疗 ,探讨该入路治疗岩斜脑膜瘤的要点。方法　总结岩斜脑膜瘤的临床表现、神经影像学特征和术中要点。结果　肿瘤全切除 10例 ,次全切除 1例 ,大部切除 1例 ,术后好转率 83.3%。结论　大型岩斜脑膜瘤首选乙状窦前入路 ,掌握术中暴露要点和分离技巧可提高手术疗效     

岩斜区脑膜瘤显微手术后并发症的护理

目的探讨岩斜区脑膜瘤显微手术后的护理方法和特点。方法总结34例岩斜区脑膜瘤显微手术治疗后的护理体会。结果33例患者临床症状明显缓解,愈后良好,无由于护理不当造成的并发症。结论岩斜区脑膜瘤术后护理对患者的康复是必要的。     

岩斜区脑膜瘤的治疗现状与进展

岩斜区位于颞骨岩部背面与枕骨斜坡部的岩斜裂汇合处,从岩骨尖至颈静脉孔。内侧至斜坡中线,外侧至第Ⅴ、Ⅶ和Ⅷ脑神经,上缘为鞍背,下缘为颈静脉孔水平;下方为枕骨大孔区[1]。岩斜区脑膜瘤由于位置深,毗邻重要解剖结构,很难实现肿瘤全切除,且有较高的术后致残率,一直是神经外科手术     

岩斜区脑膜瘤切除术患者的围手术期护理

<正>岩斜区脑膜瘤发病率较其他脑膜瘤发病率低,肿瘤身居后颅凹中央,而且临近脑干、第Ⅲ～Ⅳ对颅神经以及后循环动脉,岩斜区脑膜瘤是所有脑膜瘤中最难以处理的肿瘤之一[1]。所以围手术期护理显得尤为重要。我科2004年～2011年对10例岩斜区脑膜瘤患者围手术期术前准备和术后并发症的观察,并根据吉林大学第一医院神经外科住院患者及术后患者护理评估表,对患者做出积极、准确的评估,提出了积极有效的围手术期护理,对预防术后并发症,促进患者康复具有极其重要的作用。     

乙状窦前入路切除岩斜区脑膜瘤

目的 探索岩斜区脑膜瘤的手术入路及手术方式,并评价其疗效.方法 采用乙状窦前入路,应用显微神经外科技术,将岩斜区脑膜瘤分块行全切或部分切除.结果 9例病例中肿瘤全切6例,占66.6%;次全切除2例,占22.2%;大部分切除1例,占11.2%.无手术死亡病例,术后7例随访,平均20个月.6例正常生活,1例生活自理.MRI随访5例,未见肿瘤复发或再生长.结论 采用乙状窦前入路、应用显微神经外科技术治疗岩斜区脑膜瘤,能提高该病治愈率,减少并发症.     

Surgical treatment of petroclival meningioma: a report of 15 cases

目的 探讨岩斜脑膜瘤的临床特点、手术策略、手术技巧和治疗效果.方法 回顾性分析临床资料完整的15例岩斜脑膜瘤病例,总结其临床特点.本组均采用经Kawase入路,手术策略为全切除岩斜区肿瘤,术后辅以γ刀治疗.分析手术后颅神经功能和患者生存状况.结果 头痛头晕、外展麻痹和面部麻木是岩斜脑膜瘤的主要症状.手术近全切除肿瘤13例,次全切除2例.12例残余肿瘤术后行γ刀治疗.无手术死亡,术后无新增颅神经损害6例,出现动眼神经麻痹6例,面部麻木7例,外展功能障碍4例,面瘫7例.随访6～59个月(平均38.6个月),12例恢复正常工作和生活,2例生活自理,1例生活需他人照顾.13例无肿瘤复发,2例残余肿瘤增大者中1例经γ刀治疗肿瘤生长得到控制.动眼神经麻痹和面瘫均改善,面部麻木5例部分缓解,外展功能障碍无明显改善.结论 对岩斜脑膜瘤应采用合理的手术策略,尽可能减少手术引起的神经损害,有利于提高患者的生存质量.     

蝶骨嵴脑膜瘤的手术治疗

目的: 分析蝶骨嵴脑膜瘤的手术治疗要点。方法: 对17例蝶骨嵴脑膜瘤(其中内侧型10例,外侧型7例)的手术资料作回顾性分析。结果: 肿瘤全切除13例,次全切除3例,部分切除1例。2例术后视力障碍较术前加重,1例术后出现对侧肢体瘫痪。结论: 在不损伤重要神经血管的前提下最大限度地切除肿瘤,残余瘤体可以术后放疗。     

Surgical strategies for petroclival meningioma in 57 patients

Background Resection of petroclival meningioma （PCM） is difficult for neurosurgeons and usually brings poor performance status. In this study, we evaluated the possible risk factors for unfavorable clinical outcomes of surgical treatment of PCM, and tried to explore the optimal surgical strategies for better postoperative quality of life.Methods We recruited 57 patients （14 male, 43 female, mean age, 50.5 years） who underwent surgical resection of PCM in Huashan Hospital during 2002-2006. The primary outcomes including postoperative neurological deficits,modified Rankin scale （mRS） score and recurrence rate were evaluated, and all potential risk factors were assessed by the X2 test. Odds ratio and 95% confidence interval were calculated by univariate Logistic regression. The mean follow-up time was 34 months.Results Gross total resection was achieved in 58% of patients. One patient died during the perioperative period because of intracranial hemorrhage. Sixty-seven percent of patients experienced new postoperative neurological deficits and 26% had a higher mRS score at follow-up assessment. Postoperative complications were observed in 24 patients.Within the follow-up period, radiographic recurrence occurred in 12.3% of patients at a mean follow-up of 42 months.Postoperative radiosurgery was administered to 19 patients who had residual tumors or recurrence and no furtherprogression was found. Tumor adhesion, hypervascularity and engulfment of neurovascular structures were three risk factors for increased mRS score （P=0.0002; P=0.0051; P=0.0009）. Tumor adherence to adjacent structures clearly affected the extent of resection （P=0.0029）. The risk of postoperative cranial nerve deficits increased with tumor engulfment of neurovascular structures （P=0.0004）.Conclusions Intraoperatively defined tumor characteristics played a critical role in identifying postoperative functional status. An individual treatment strategy after careful preoperative evaluation could help improve quality of life.     

Chordoid meningioma: a report of two cases

Although meningiomas are common rumors in adults, the chordoid variant is very rare. According to the World Health Organization Classification of Tumors of the Nervous System （Lyon, 2000）,chordoid meningioma together with another rare variant, lymphoplasmacyterich meningioma, usually contain abundant lymphoplasmacytic infiltration, and are associated even with hematological abnormalities, especially in young adults. Few cases of chordoid meningioma have been reported in detail until Couce and his colleagues reported a sizable series of forty-two cases. Even then, the clinical and pathological features of these tumors were not well characterized, because of variations in different papers. In the present article, we report two adult patients with chordoid meningioma.     

基层医院开展脑膜瘤手术治疗31例临床体会

目的 阐述脑膜瘤的手术治疗及效果。方法31例脑膜瘤均采用开颅手术治疗,3例术前采用同侧颈外 动脉结扎术。结果全部成功,无一例死亡,未见肿瘤复发:结论脑膜瘤适合手术切除,效果好。     

Sphenoid wing meningioma en plaque: report of 37 cases

Background Sphenoid wing meningioma en plaque is a special morphological subgroup of intracranial meningiomas, defined by a carpet-like, soft tissue component that infiltrates the dura and invades the sphenoid wing and orbit associated with a significant hyperostosis. This report summarized our experiences in 37 patients with sphenoid wing meningioma en plaque who had been treated with transcranio-orbital approach surgery. Methods A retrospective study was made on clinical manifestations, neuroradiological features, and operative techniques in 37 patients undergoing transcranio-orbital approach from Sep. 1998 to Apr. 2009. Patients ages： 16 years to 67 years, 45.5 years in average; sex： 15 males, 22 females. Chief complaints were progressive proptosis and visual acuity deficits. All patients were operated on using a fronto-temporal approach with orbital decompression. The extent of tumor resection and postoperative complications were investigated. Results Simpson grade Ⅱ resection was achieved in 9 patients, Simpson grade Ⅲ in 22 patients and Simpson grade Ⅳ in 6 patients. Pathological examination showed 27 （73%） patients were meningothelial meningiomas. After surgery, proptosis improved in all patients, visual acuity improved in 18 patients （69%）. Temporary ophthalmoplegia was found in 8 patients, cerebrospinal fluid leak was found in 1 patient. Duration of follow up was from 3 months to 9 years, tumor recurred in 7 patients, and 5 patients underwent second surgery, including two trans-nasal endoscopic surgeries to resect sphenoid sinus-involved tumor. There were no operation-related deaths or other significant complications. Conclusions Sphenoid wing meningioma en plaque, mainly meningothelial meningiomas, are more likely to produce adjacent hyperostosis and have characteristic radiological appearances. All the hyperostosis bone of the great wing of sphenoid bone should be removed to prevent recurrence. Extensive tumor removal with bony decompression at the orbital apex can produce satisfactory cosmetic and functional outcome. Close co-operation between the neurosurgeons and the ophthalmologists is important.     

鞍区及鞍旁脑膜瘤35例显微外科治疗体会

目的：总结鞍区及鞍旁脑膜瘤的影像学特点、手术入路及手术效果，以提高其治疗效果。方法：回顾分析1997年至今收治的35例鞍区及鞍旁脑膜瘤，瘤体最大径为3—6．7cm，平均5．36cm，其中单侧额下经纵裂或不经纵裂入路切除18例，采用翼点或扩大翼点入路切除17例。结果：肿瘤全切除(Simpson I、II)31例，近全切除4例，无手术死亡。术后颅高压症状均有缓解，18例有视力视野障碍者，改善11例，无改变5例，变差2例。结论：对于鞍上向前方、上方生长以及鞍内脑膜瘤甚至向蝶窦内生长者，可以采用单侧额下经纵裂入路；而对于向侧方或后方生长的鞍区脑膜瘤，可采用翼点入路或扩大翼点入路，两者均能获得良好的肿瘤暴露，全切除率较高。     

蝶骨嵴脑膜瘤的临床特征及显微外科治疗(附27例报告)

目的探讨蝶骨嵴脑膜瘤的临床表现和显微外科治疗效果。方法回顾性分析武汉大学人民医院2005年5月—2010年5月收治的27例蝶骨嵴脑膜瘤的临床资料。结果临床表现为颅内压增高17例,视力障碍14例,癫痫5例。影像学检查巨大型(直径>7.0cm)2例,大型(4.6～7.0cm)16例,小型(≤4.5cm)9例。肿瘤全切除20例(74.1%),次全切除5例(18.5%),部分切除2例(7.4%)。1例术后放弃治疗死亡,余病例无严重并发症发生。结论蝶骨嵴脑膜瘤患者的临床症状不典型,诊断主要依据CT和MR。娴熟的显微操作技术、选择正确的手术入路以及术中神经和血管保护是手术成功的关键。