脑膜瘤显微外科切除的临床分析(附47例报告)

目的：回顾分析脑膜瘤的临床特点及治疗经验。方法：回顾性总结了自1998年10月至2003年5月间我科收治的颅内各种类型脑膜瘤47例;对其临床特点、手术方法及预后进行总结分析。结果：脑膜瘤切除达到Simpson Ⅰ、Ⅱ级切除38例,Ⅲ级切除6例,Ⅳ级切除3例,手术恢复良好36例,术后出现新的颅神经功能损害4例,不全偏瘫5例,手术死亡2例：结论：深入分析脑膜瘤的临床特点,结合显微手术技术是脑膜瘤获得良好治疗的保证。     

24例脑膜瘤诊疗分析

回顾分析24例脑膜瘤的病例特点及治疗经过,总结脑膜瘤的特点及治疗经验。结果 24例脑膜瘤中巨大型脑膜瘤4例,大型5例;中型11例;小型4例;2例巨大脑膜瘤仅做到Simpson 4级切除,死亡1例,偏瘫1例;1例小脑脑膜瘤由于骨瓣设计过小,仅做到4级切除;其余均做到Simpson 2级切除,预后良好。早期诊断是治疗脑膜瘤的关键,周密的术前计划有利于巨大脑膜瘤和窦旁脑膜瘤的治疗。     

39例镰旁脑膜瘤的显微手术治疗体会

目的探讨大脑镰旁脑膜瘤的显微手术治疗的方法与技巧。方法回顾性分析2004年5月至2009年6月,39例大脑镰旁脑膜瘤的临床资料。结果根据骑跨大脑镰的位置选择手术入路,应用显微手术切除大脑镰旁脑膜瘤39例,其中34例肿瘤SimposonⅠ级切除,3例SimpsonⅡ级切除,1例SimpsonⅢ级切除,1例Ⅳ级。术后随访6—36个月,恢复良好,手术死亡1例,无肿瘤复发。结论采用显微外科技术能提高骑跨大脑镰脑膜瘤的全切率,降低复发率,减少残死率;如果全切肿瘤可能带来重要的神经功能损害,应考虑分期手术或者残留部分肿瘤。手术切除程度可达SimpsonⅠ—Ⅳ级;良好的手术暴露、有效地控制术中出血、保护并妥善处理好上矢状窦和避免脑皮质损伤是提高手术疗效的关键因素。     

显微外科手术治疗蝶骨嵴脑膜瘤

目的总结蝶骨嵴脑膜瘤显微外科手术技巧,提高治疗效果。方法对15例行显微手术治疗的蝶骨嵴脑膜瘤患者的临床资料进行回顾性分析。结果 15例患者肿瘤均行显微手术切除,其中SimpsonⅠ切除2例,SimpsonⅡ切除7例,SimpsonⅢ切除4例,SimpsonⅣ切除2例,无手术死亡病例。肿瘤按病理分型：纤维型3例,内皮型7例,血管型4例,混合细胞型1例。所有患者术后均随访6个月～3年,SimpsonⅠ、Ⅱ者无复发,SimpsonⅢ、Ⅳ者各复发1例。结论显微手术治疗蝶骨嵴脑膜瘤可提高全切率,术中在保护重要神经血管的前提下尽量切除肿瘤,术后行放射治疗,可获更好的治疗效果。     

前颅底、蝶骨嵴大型脑膜瘤的显微手术治疗

目的:总结前颅底、蝶骨嵴大型脑膜瘤显微手术治疗经验。方法:对21例前颅底、蝶骨嵴大型脑膜瘤患者的影像学资料、手术入路、显微手术切除的方法及疗效进行分析。结果:按照Simpson切除标准,本组21例中Ⅰ级切除14例,Ⅱ级切除2例,Ⅲ级切除1例,Ⅳ级切除4例;术后复发1例再次手术切除;术中无死亡或出现凶险大出血病例。结论:肿瘤全切除是预防复发的有效措施,充分的术前影像学检查及评估,术中保护重要神经与血管,能明显提高肿瘤的全切除率,减少并发症。     

矢状窦旁脑膜瘤的显微手术治疗(附67例报告)

目的:探讨矢状窦旁脑膜瘤的手术方法与技巧。方法:回顾性分析67例矢状窦旁脑膜瘤的临床资料。结果:61例肿瘤全切除,其中22例SimpsonⅠ级切除,39例SimpsonⅡ级切除,余6例SimpsonⅢ级切除。术后随访6~36个月,恢复良好,无手术死亡。结论:矢状窦旁脑膜瘤的手术切除程度可达SimpsonⅠ~Ⅱ级;良好的手术暴露、有效地控制术中出血、保护并妥善处理好上矢状窦和避免脑皮质损伤是提高手术疗效的关键因素。     

间变性脑膜瘤六例报道及文献复习

目的探讨间变性脑膜瘤的临床诊断、治疗特点。方法回顾性分析2004年9月至2011年12月行开颅手术治疗并经术后病理诊断为间变性脑膜瘤6例患者的临床资料。结果 6例患者中男女比例为5∶1;3例表现为头晕、头痛、恶心、呕吐,1例表现为抽搐,1例表现为偏瘫,1例表现为头痛、嗅觉及精神异常;4例行肿瘤全切(SimpsonⅠ级),2例行肿瘤次全切或大部分切除(SimpsonⅡ～Ⅲ级),6例患者术后均复发(其中1例有颅内转移);3例初次手术后行普通放疗,1例行γ-刀治疗,1例行再次手术切除并普通放疗,1例手术治疗后再未行放疗。4例得到随访,时间1个月～8年,平均4.5年,2例恢复正常工作劳动,3例生活能自理,1例因多次肿瘤复发最终导致死亡。结论间变性脑膜瘤的临床特点与良性脑膜瘤相比有显著差异,手术切除+术后放疗或立体定向神经外科放疗最大限度地抑制残留瘤细胞的增殖,延长患者的生存期。     

蝶骨嵴脑膜瘤的手术治疗

目的:探讨蝶骨嵴脑膜瘤的诊断、分型、手术入路、切除方式并总结手术治疗效果。方法:回顾性分析27例蝶骨嵴脑膜瘤患者的临床表现、影像学资料、手术入路、切除程度和其中25例患者的随访资料。结果:肿瘤全切(Simpson Ⅰ级和Ⅱ级)18例(66.67%),次全切9例(33.33%),死亡1例。术后患者颅内高压、视力下降及眼球突出等临床症状均有不同程度地改善和恢复。随访25例6个月-7年,复发3例,1例行二次手术。结论:术前应根据肿瘤的位置及周围结构受累的情况选择合适的手术入路及切除方式,熟练掌握术区解剖及显微手术操作,可以提高肿瘤全切率,减少术后并发症,降低致残率和复发率。     

巨大型嗅沟脑膜瘤的手术切除

[摘 要]目的 总结巨大嗅沟脑膜瘤手术切除方法。方法 回顾性分析12巨大嗅沟脑膜瘤的临床特点，手术切除技巧。结果 按照Simpson手术切除分级，Ⅰ级切除8例,Ⅱ级切除4例。1年后全部患者得到随访，手术后全部患者嗅觉无改善，有一例术前视力为光感的患者手术后视力无改善，其余11例患者均恢复正常生活能自理。结论 手术切除是治疗巨大嗅沟脑膜瘤的唯一方法，手术切除需要详尽的术前设计和娴熟的显微神经外科操作技术。     

经翼额入路鞍结节脑膜瘤显微手术治疗21例分析

目的探讨鞍结节脑膜瘤的手术入路和手术技巧,以改善手术治疗效果。方法回顾性分析2000-01-2009-12经翼额入路手术治疗的鞍结节脑膜瘤21例。结果 21例肿瘤中,SimpsonⅠ级切除5例,SimpsonⅡ级切除15例,SimpsonⅢ级切除1例,无死亡病例,视力明显改善15例。结论显微镜下经翼额手术入路是治疗鞍结节脑膜瘤的一种有效的方法,手术操作空间大,便于保留重要结构,使患者生存质量提高,具有较好的临床价值。     

侧脑室脑膜瘤手术治疗

目的侧脑室脑膜瘤发病率低,手术入路亦有差别,特别在优势半球尤为明显。该文讨论侧脑室脑膜瘤最佳手术方案。方法通过13例侧脑室脑膜瘤手术治疗,使手术入路最大限度暴露肿瘤及供血血管,而不损害高级功能区;运用显微外科技术分块切除肿瘤。结果9例经项枕入路;2例经颞入路;1例经额入路;1例经胼胝体后入路。肿瘤全切除,无死亡;仅1例发生偏盲,其他病人症状均有不同程度改善。结论肿瘤大小、位置、供血影响手术入路的选择;顶枕入路适合侧脑室三角区脑膜瘤;运用显微技术,分块切除肿瘤可以减少术后并发症。     

磁共振灌注成像诊断良恶性脑膜瘤

目的 探讨脑膜瘤相对性脑血流容积(rCBV)与脑膜瘤良恶性间的关系.方法 对36例经手术病理证实的脑膜瘤患者术前行常规MR及MR灌注成像(PWI)检查.PWI序列为GRE-EPI-T2~*WI,原始灌注图像数据经工作站软件计算出脑血流容积(CBV)图,获取脑膜瘤最大rCBV值,分析良恶性脑膜瘤肿瘤实质区与周围水肿区间rCBV值的差异.结果 良恶性脑膜瘤肿瘤实质区最大rCBV值分别为9.78±4.69、3.59±0.28 (t=7.168, P<0.001);周围水肿区最大rCBV值分别为3.06±1.76、3.58±1.93 (P>0.05).结论 MR PWI的rCBV值及CBV图是评价脑膜瘤良恶性的有价值的指标,对指导临床选择正确的治疗方案及评估预后具有重要意义.     

大脑镰旁脑膜瘤的显微外科治疗

目的　探讨大脑镰旁脑膜瘤的手术方法和治疗效果。方法　对手术治疗的１８例大脑镰旁脑膜瘤患者的影像学资料、手术入路、显微手术切除肿瘤的方法及策略进行回顾性分析。结果 按Simpson切除标准，I级切除10例，II级切除6例, Ⅲ级切除 2例随访1至2年，2例复发,无死亡病例。结论 术前影像学评估，合适的手术入路，细致的显微操作,能明显提高肿瘤的全切除率，降低复发和其他并发症。     

Cooperative neuro-otologic management of acoustic neuromas and other cerebellopontine angle tumors

Over a recent 16-month period, 35 cerebellopontine angle tumors were removed at our institution by a surgical team consisting of one neurosurgeon and one otologist. Nineteen tumors were less than 2 cm in diameter and six were greater than 4 cm. There were 26 acoustic neuromas, six meningiomas, two epidermoid tumors, and a glossopharyngeal schwannoma. A suboccipital transmeatal approach was used in the majority of patients. There were no deaths. Thirty-two patients had an excellent outcome. Twenty-four patients had complete tumor removal (92% of the acoustic neuromas). The facial nerve was preserved anatomically in all but one patient, who had nerve grafting intraoperatively and has partial recovery of function. Thirteen of the 24 patients who had auditory function retained some of it postoperatively. With current diagnostic techniques, combined with the neurosurgical and otologic team approach, the majority of patients with acoustic tumors of all sizes may expect a complete resection of the tumor with a good outcome. Certainly, early diagnosis and resection of smaller tumors will increase the likelihood that hearing will be preserved, thus providing impetus for aggressive diagnostic and surgical treatment of patients with these lesions.     

脑室内脑膜瘤的MRI诊断

目的：探讨脑室内脑膜瘤的MRI特征及提高MRI诊断脑室内脑膜瘤特异性。方法：回顾分析临床资料完整的脑室内脑膜瘤8例MRI表现，其中良性7例，恶性脑膜瘤1例。结果：脑室内脑膜瘤8例生长部位均发生在侧脑室内，其中三角区6例，体部2例；8例增强扫描均有较明显均匀强化，5例有瘤周水肿。本组术前定位准确率为100％，术前定性诊断准确率为62．5％。结论：MRI能准确显示脑室内脑膜瘤的位置和病变范围，定性诊断需综合考虑患年龄、肿瘤在脑室内的准确位置及MRI平扫和增强的表现。     

Meningioma in four patients with human immunodeficiency virus infection

We describe four patients infected with the human immunodeficiency virus (HIV) who had development of meningiomas. In contrast to those in the general population who have meningiomas, all our patients were young men; the mean age was 40 years (range, 32 to 50). Their risk behavior for HIV was homosexuality (three patients) and intravenous drug use (one patient). The CD4+ cell count in each of the three homosexual men was less than 50/microL and was 280/microL in the drug user. Imaging studies showed enhancing lesions in three of the patients. Although each of these meningiomas could have occurred in otherwise normal young to middle-aged men, we speculate that the meningiomas may have grown in these HIV-infected hosts because of either loss of immune function or dysregulation of cytokines.     

Double filtration plasmapheresis in the treatment of inflammatory polyneuropathy.

Twelve cases of recognized inflammatory polyneuropathy were treated by plasmapheresis (PP) at Shin-Kong Wu Ho-Su Memorial Hospital from November 1993 to November 1995. These include 6 cases of acute inflammatory demyelinating polyneuropathy (AIDP), 4 cases of chronic inflammatory demyelinating polyneuropathy (CIDP), one case of Fisher syndrome, and one case of Sj?gren's syndrome with polyneuropathy. The patients chosen for PP met the inclusion criteria of severely disabled, i.e., Grade 4 (bed or chair bound) or Grade 5 (required assisted ventilation), or an unremittingly progressive course. Plasmapheresis was carried out by the double filtration method. Each patient received a standard course of at least 4 sessions of pheresis. All the patients receiving PP showed a beneficial response. The treatment for 10 patients was judged to be effective. The other 2 patients (one AIDP and one CIDP), though improved, were unable to reach Grade 2. Among the complications of PP, only 4 episodes of symptomatic hypotension were noted in a total of 73 sessions of PP. In conclusion, PP is safe and effective in treating inflammatory polyneuropathy.