颅眶沟通性脑膜瘤的显微外科切除和眶顶重建

目的　本研究旨在探讨颅眶沟通性脑膜瘤的诊断、手术及预后。方法　收集我科 1 996年 1月～2 0 0 3年 7月入院的 32例颅眶沟通瘤病人中经病理确诊为脑膜瘤的 1 4例病人资料 ,就其临床表现、影像学变化、手术操作、病理特点和预后等方面予以总结和分析。结果　采用额下或额颞侧方入路 ,单纯硬膜外切除 9例 ,联合硬膜外、硬膜下切除 5例。全切 1 1例 ,大部切除 3例。随访 8例 ,3例接受立体定向放射治疗 ,5例未行放射治疗 ;复发 3例 ,均未行术后放疗。结论　颅眶沟通性脑膜瘤可以侵犯颅眶结合部许多重要解剖结构 ,且有复发倾向 ;本病治疗应强调充分暴露、彻底切除、骨性重建和术后放射治疗。

Surgical management of cranio-orbital meningiomas and reconstruction of skull base defects

Objective To explore the diagnosis, surgical resection, and prognosis of the cranial orbital communicating meningiomas. Methods Of the 32 patients with cranio-orbital communicating neoplasms admitted to the hospital from January 1996 to July 2003, 14 cases were diagnosed pathologically as meningiomas and all the aspects of the clinical manifestations, image changes, operative manipulation, morphological characteristics, and the prognosis were summarized and analyzed. Results Subfrontal or fronto-temporal lateral approach was performed, with purely epidural resection in 9 cases, and combination of epidural and subdural resection in 5 cases. Total removal was achieved in 11 cases, subtotal in 3. Among the 8 cases that had been followed up, 3 underwent stereotactic radiation therapy, and 5 did not; 3 recurred never with radiation therapy. Conclusion The cranial orbital communicating meningioma invades many vital anatomical structures in cranio-orbital junction, and tends to recur. Perfect exposure and radical removal, bone reconstruction, and postoperative radiotherapy should be much emphasized on dealing with this disease.