68例颅内大型脑膜瘤的显微手术治疗

目的 总结颅内大型脑膜瘤显微外科手术的要点和术后并发症的防治经验，以进一步提高颅内大型脑膜瘤手术治疗效果。方法 对从2001年1月至2006年8月在我科显微手术治疗的68例颅内大型（最大径〉4．5cm）脑膜瘤患者的临床资料进行回顾性分析，并对大型脑膜瘤屁微手术要点和术后并发症的防治进行分析。结果本组颅内大型脑膜瘤68例，按脑膜瘤切除的Simpson分级，Ⅰ级36例，Ⅱ级23例，Ⅲ级8例，Ⅳ级1例；全切率（包括按Simpson分级的Ⅰ、Ⅱ级）为86．8％（59／68）。颅底大型脑膜瘤中，嗅沟脑膜瘤、蝶骨嵴脑膜瘤、鞍区脑膜瘤的手术全切率分别达到了77．8％（7／9）、75．0％（9／12）、60．0％（3／5）。本组无死亡病例（术后6周内统计）。结论 显微手术切除是目前治疗颅内大型脑膜瘤的首选方法。良好的显微手术技术和对颅内各部位特别是颅底解剖的熟悉是提高手术全切率和减少术后并发症的前提。积极预防、正确诊断和及时治疗术后并发症能有效降低患者的死亡率和致残率。

Microsurgery for Large Intracranial Meningiomas (a Report of 68 Cases)

Objective To summarize the operative gists and the experiences in preventing and treating the postoperative complications in order to enhance the curative effect of microsurgery on the large intracranial meningiomas. Methods The clinical data of 68 patients with large intracranial meningiomas （diameter〉4.5 cm）, who underwent microsurgery from January 2001 to August 2006 in our hospital, were analyzed retrospectively. The operative gists and the measures of preventing and treating the postoperative complications were discussed. Results According to Simpson grading of resecting meningiomas, Simpson grade Ⅰ resection of meningiomas was reached in 36 cases, grade Ⅱ in 23 cases, grade Ⅲ in 8 cases and grade Ⅳ in 1 case. The rate of total （Simpson grades Ⅰ - Ⅱ） resection of the tumors was 86.8% （59[68）. The rates of total resection of the large intracranial meningiomas in the olfactory sulci, the cristae sphenoidalis and the sellar areas were 77.7% （7[9）, 75.0% （9[12） and 60.0% （3[5） respectively. No patients died within 6 weeks after the operation. Conclusion The microsurgical resection is the primary method to treat the large intracranial meningiomas. The skillful microsurgical technique and familiarity with intracranial anatomy, especial the anatomy of cranial base, are necessary for the surgeons to decrease the postoperative complications and to enhance the rate of total resection of the tumors in the patients with large intracranial meningiomas. The positive prevention, exact diagnosis and prompt treatment of the postoperative complications can effectively reduce the operative mortality and the disabled rate.