脑室内脑膜瘤的分布及显微手术治疗

目的 探讨脑室内脑膜瘤的分布及显微手术的疗效.方法 对35例行显微手术治疗的脑室内脑膜瘤患者的临床资料及手术效果进行分析总结.结果 30例位于一侧侧脑室,2例位于双侧侧脑室,1例位于侧脑室+第三脑室,1例位于第三脑室,1例位于第四脑室;其中30例全切(SimponⅠ,Ⅱ),4例次全切(Simpon Ⅲ),Ⅰ例大部分切除;术中去骨瓣减压3例,手术死亡1例.术前有颅高压23例术后早期缓解20例,加重3例;随访3个月-8年,7例肢体活动障碍者6例改善,1例加重;4例偏盲者2例改善,2例无变化;伴有脑积水5例,3例缓解,1例行脑室-腹腔分流术,1例行第三脑室底造瘘术.全切病例中,1例肿瘤复发行二次手术;失访3例.结论 脑室内脑膜瘤多位于侧脑室三角区,其位置深在,但显微手术的疗效良好.

Microsurgical management of intraventricular meningiomas

Objective To explore the distribution and microsurgical outcome of intraventricular meningiomas. Methods A retrospective analysis of the clinical data and prognosis of microsurgery was performed in 35 intraventricular meningioma cases. Their clinical manifestations and surgical outcomes were analyzed in order to evaluate the significance of microsurgery. Results Of the 35 intraventricular meningioma cases, 30 were located in single lateral ventricle, 2 in bilateral ventricles, 1 in lateral ventricle and the third ventricle, 1 in the third ventricle and 1 in the fourth ventricle. Total and sub-total resection of tumor were achieved in 30 and 4 cases, respectively. Partial tumor resection was obtained in 1 case.Decompression was undertaken in 3 cases during the operation because of brain edema. One postoperative death occurred.At the early stage after operation, 20 of the 23 patients released from the increased intracranial pressure. All patients were followed up for about 3 months to 8 years, in which 6 of 7 cases recovered from hemiplegia, 2 of 4 cases recovered from hemianopia, 3 of 5 cases released from hydrocephalus and the other 2 cases resorted to V-P shunt and ventriculostomy of the third ventricle,respectively. One case suffered from tumor recurrence and undertook the second surgery. Three patients were lost during the follow-up period. Conclusion Intraventricular meningiomas most commonly arise from the trigone of lateral ventricles. Although their location is always deep, satisfactory clinical outcome of microsurgery for intraventricular meningiomas could be achieved.