鞍结节脑膜瘤的显微手术治疗

目的 探讨鞍结节脑膜瘤的手术入路及显微手术治疗效果。方法 回顾性分析2013年1月至2018年1月显微手术治疗的46例鞍结节脑膜瘤的临床资料，经单侧额下-纵裂入路19例，额外侧入路13例，翼点入路9例，眶上锁孔入路5例。结果 Simpson Ⅰ级切除32例，Ⅱ级切除9例，Ⅲ级切除5例。术后出现短暂尿崩2例，1例经眶上锁孔入路肿瘤切除术后出现脑脊液鼻漏，无死亡病例。全部病人术后随访6~50个月，平均26个月。术前28例视力障碍中，24例视力改善，2例加重，2例失明未恢复。肿瘤复发3例。结论 根据肿瘤部位、大小、生长方式，选择合适的手术入路，以及术中注意保护肿瘤比邻重要结构，是提高鞍结节脑膜瘤手术疗效、减少并发症的关键。

Microsurgery for tuberculum sellea meningiomas (report of 46 cases)

Objective To investigate the curative effect of microsurgery on tuberculum sellea meningiomas. Methods The clinical data of 46 patients with tuberculum sellae meningiomas, of whom, 19 underwent microsurgery via subfrontal interhemispheric fissure approach, 13 via lateral frontal approach, 9 via pterional approach and 5 via supra-orbital key hole approach, were analyzed retrospectively. The extent of tumor resection was assessed by Simpson classssification. Results Simpson grade Ⅰ resection was achieved in 32 cases, grade Ⅱ in 9 and grade Ⅲ in 5. The postoperative transient diabetes insipidus occurred in 2 patients. The postoperative cerebrospinal fluid rhinorrhea occurred in 1 patient undergoing surgery via supra-orbital approach. No patient died. All the patients were followed up from 6 to 50 months (mean, 26 months). Of 35 patients with preoperative different degrees of visual impairment, 26 had improvement of the visual power, 7 unchanged. and 2 deteriorated. The tumors recurred in 3 cases during the following up. Conclusions It is very important to choose the proper surgical approach according to the tumorous region, size and growth pattern. The intraoperative attention to protecting the important structures adjacent to the tumors is the key to improvement of the surgical effect and reducing the postoperative complications in the patients with tuberculum sellae meningiomas.