翼点硬脑膜外入路切除前床突脑膜瘤

目的探讨前床突区手术临床应用解剖,提高前床突区肿瘤的治疗效果。方法回顾性总结了1998年至2004年采用翼点硬脑膜外入路手术治疗的前床突脑膜瘤12例,其中男4例,女8例,年龄36～58岁,平均42.2岁,视力减退者10例,头痛者11例。手术一般采用经眶上翼点联合入路,但对肿瘤累及海绵窦者采用经额颞眶颧联合入路。磨除前床突。硬脑膜外阻断肿瘤基底部血供。硬脑膜下切除肿瘤。结果前床突脑膜瘤共12例,全切除8例,次全切除3例,部分切除1例。全组无手术死亡。术前视力明显减退的10例患者,术后6例明显好转,2例改善,1例无变化,1例较术前恶化,其中术后视力无改变和视力恶化的2例均为术前有明显视神经萎缩者。结论前床突脑膜瘤采用翼点硬脑膜外入路手术,磨除前床突,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。眶上翼点联合入路可明显减少对脑组织的牵拉,有利于大型肿瘤上极的显露和切除。

Application of Pterional Epidural Approach to Surgery of Large Clinoidal Meningiomas

Objective To investigate the clinical applied anatomy in the region of anterior clinoid process and to improve the therapeutic effect of surgery on the clinoidal tumors. Methods The clinical data of 12 patients with clinoidal meningiomas undergoing surgery through the pterional epidural approach from January 1998 to August, 2004 were analyzed retrospectively. Of these 12 patients, 4 were male and 8 female. Their age varied from 36 to 58 years old. The vision failed in 10 patients and there was headache in 11 patients. The patients were treated by surgery through supraorbital-pterional approach, or cranioorbital zygomatic approach (when tumors involved cavernous sinus). Anterior clinoid process was cut off with high-speed driller. The blood supply to the tumors base was epidurally blocked. The tumors were intradurally resected. Results Of the 12 patients with large clinoidal meningiomas, 8 received total removal of the tumors, 3 subtotal removal and 1 part. Of the 10 patients with pre-operative severe visual failure, 6 was markedly improved in vision, 2 a little, 1 not and 1 post-operatively suffered from worse vision. Nobody died in this group. Conclusions The epidural approach through which the surgery is performed for the clinoidal meningiomas, and cutting off the anterior clinoid process, were helpful to blocking blood supply to the tumors base and detaching the infraclinoidal tumor from the internal carotid artery. The supraorbital-pterional approach can minimize brain retraction and was advantageous to exposing and resecting the superior pole of the giant clinoidal meningioma.