巨型鞍结节脑膜瘤的显微外科治疗

目的 总结、分析巨型鞍结节脑膜瘤(MTSM)的病理解剖及血供特点,探讨其相应的显微外科治疗对策.方法 回顾分析1998至2010年应用显微神经外科技术、理念,针对MTSM独特的病理解剖、血供特点,采取颅底入路、术中控制性降压、利用"肿瘤通道"原位切除的16例巨型鞍结节脑膜瘤患者的临床资料,其中男5例,女11例,年龄26～65岁,平均48.5岁;随访14例,时间4～132个月,平均74.9个月.结果 肿瘤最大径51.1～76.2 mm,平均5 8.9 mm;Simpson Ⅰ、Ⅱ、Ⅲ及Ⅳ级切除分别为3、9、3及1例;术后死亡1例,视力不同程度好转10例,无变化2例,恶化2例,短暂尿崩9例.结论 深入研究MTSM独特的血供、病理解剖特点至关重要,针对性地采取相应的显微外科对策、利用"肿瘤通道"原位手术切除应为MTSM较为理想的治疗方案.

Abstract：

Objective To summarize the characteristics of the pathological anatomy and blood supply model of massive tuberculum sellae meningiomas (MTSM) and explore its corresponding microneurosurgical strategies. Methods The clinical data of 16 MTSM patients were reviewed retrospectively. From January 1998 to January 2010, according to their unique pathological anatomy and blood supply model, all patients underwent microneurosurgical removal with induced hypotension through tumor corridor by the bi-subfrontal anterior longitudinal fission ( n = 14), right frontolateral approach ( n =1 ) and pterional approach (n = 1 ). There were 5 males and 11 females with a mean age of 48. 5 years old ( range: 26 - 65 ). But the mean follow-up period was 74. 9 months ( range: 4 - 132) in 2/4 cases. Results Among all cases, the mean tumor diameter was 58.9 mm ( range: 51.1 - 76. 2 mm). Simpson grade Ⅰ, Ⅱ ,Ⅲ, Ⅳ removal of MTSMs were accomplished in 3, 9, 3 and 1 case respectively. One case died within 4postoperative days. Visual acuity improved in 10 patients, remained unchanged in 2 and deteriorated in 2.Transient postoperative diabetes insipidus occurred in 9 cases. Conclusion It is critical to understand the unique characteristics of pathological anatomy and blood supply model of MTSM so as to adopt proper microneurosurgical strategies to remove it in situ.

Microneurosurgical treatment of massive tuberculum sellae meningiomas

Objective To summarize the characteristics of the pathological anatomy and blood supply model of massive tuberculum sellae meningiomas (MTSM) and explore its corresponding microneurosurgical strategies. Methods The clinical data of 16 MTSM patients were reviewed retrospectively. From January 1998 to January 2010, according to their unique pathological anatomy and blood supply model, all patients underwent microneurosurgical removal with induced hypotension through tumor corridor by the bi-subfrontal anterior longitudinal fission ( n = 14), right frontolateral approach ( n =1 ) and pterional approach (n = 1 ). There were 5 males and 11 females with a mean age of 48. 5 years old ( range: 26 - 65 ). But the mean follow-up period was 74. 9 months ( range: 4 - 132) in 2/4 cases. Results Among all cases, the mean tumor diameter was 58.9 mm ( range: 51.1 - 76. 2 mm). Simpson grade Ⅰ, Ⅱ ,Ⅲ, Ⅳ removal of MTSMs were accomplished in 3, 9, 3 and 1 case respectively. One case died within 4postoperative days. Visual acuity improved in 10 patients, remained unchanged in 2 and deteriorated in 2.Transient postoperative diabetes insipidus occurred in 9 cases. Conclusion It is critical to understand the unique characteristics of pathological anatomy and blood supply model of MTSM so as to adopt proper microneurosurgical strategies to remove it in situ.