小脑幕脑膜瘤显微手术治疗及手术入路选择

目的 探讨小脑幕脑膜瘤的手术治疗和手术入路选择。方法 回顾性分析2008年6月至2017年3月手术治疗的92例小脑幕脑膜瘤的临床资料。内侧型和外侧型向幕上发展者，采用扩大翼点入路10例，颞下入路23例，颞枕部入路18例；肿瘤全部或主体在颅后窝21例，采用枕下或枕部幕上下联合入路；20例镰幕型采用枕部经小脑幕入路。结果 肿瘤全切除86例，部分切除6例。无手术死亡病例。83例术后随访1~8年，正常工作、生活71例，生活自理8例，生活需要照顾4例；肿瘤复发再次手术7例（次全切除5例，全切除2例）。结论 手术全切除小脑膜脑膜瘤可获得满意效果及良好预后；根据肿瘤特点设计合适的手术入路以及熟练掌握局部神经解剖和显微神经外科技术是手术成功的关键；术中深静脉系统及大静脉窦的保护具有重要意义。

Microsurgery for tentorial meniggiomas and choice of its approach

Objective To investigate the microsurgery for tentorial meningiomas and its approach. Methods The clinical data of 92 patients with tentorial meningiomas, of whom, 10 underwent microsuegery via extended pterional approach, 23 via subtemporal one, 18 via temporo-occipital one, 21 via suboccipital one or combined sub-and supratentorial craniotomy and 20 via suboccipital transtentorial one according to the location of the tumors from June, 2008 to March, 2017, were analyzed retrospectively. Results The total resection of the tumors was gained in 86 cases and partial resection in 6 cases. No patient died. There were new postoperative neurological dysfunctions in 10 cases. The tumors recurred 1~8 years after the surgery in 8 patients. Conclusions　The curative effects of microsurgery on tentorial meningiomas are good, but it is very important to choose reasonable surgical approaches according to the location of tentorial meningiomas. The mastery of local nervous anatomy and skills of microneurosurgery are the keys to the successful microsurgical resection of tentorial meningiomas. It is great important to intraoperatively treat and protect the deep vein system and large venous sinuses in the patients with tentorial meningiomas.