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。

Microsurgical treatment of tuberculum sellae meningiomas

Objective To explore the microsurgical technique to treat the tuberculum sellae meningiomas (TSM) and the curative effect of microsurgery on them. Methods The clinical data of 45 patients with TSM, of whom, 22 underwent microsurgery via the unilateral subfrontal approach, 5 via the cerebral longitudinal fissure approach, 15 via pterional or extended pterional approach and 3 via the combined pterional and subfrontal approach from January, 2007 to July, 2013, were analyzed retrospectively. Results Simpson grade Ⅰ resection of the tumors was achieved in 23 patients, grade Ⅱ in 14, grade Ⅲ in 5 and grade Ⅳ in 3. The rate of gross total resection was 82.3% (37/45). Of 37 patients with disturbances of visual acuity and/or visual field before the operation, 27 (73.0%) were improved, 5 unchanged and 4 worsened. No patients died after the operation. Conclusions The main method to treat TSM is microsurgery. The choice of surgical approach should be based on the tumor size, growth pattern of tumor, degree of visual disturbance and experience of surgeon in the patients with TSM. Understanding the microanatomy related to the saddle area and skillful microsurgical techniques are key to the good curative effect of microsurgery on TSM.