蝶眶脑膜瘤18例手术治疗临床分析

目的 探讨经颅入路显微切除蝶眶脑膜瘤的手术方法、疗效及随访结果.方法 对18例蝶眶脑膜瘤患者选用额颞入路、眶颧入路或眶颧结合扩大前颅窝底入路硬膜外结合硬膜内切除肿瘤,在硬膜外磨除增生的蝶骨大翼骨质、眶上裂、视神经管开放减压,其中经额颞入路15例,眶颧入路2例,眶额结合扩大前颅窝底入路1例,术前、术后均有视觉功能评价、手术录像及术后影像评估肿瘤切除程度.结果 肿瘤切除程度:Simpson Ⅰ级2例,SimpsonⅡ级6例,SimpsonⅢ级8例,SimpsonⅣ级2例.18例患者术后突眼情况均有好转,视觉功能改善13例.随访6 -56个月(平均25.3个月),2例患者肿瘤复发.结论 选择合适的手术入路显微切除蝶眶脑膜瘤,可获得充分显露和眶尖、球后减压,可有效缓解突眼、视觉障碍及眼肌麻痹.因肿瘤多累及眶尖、眶上裂、海绵窦等重要结构,肿瘤难以全切,术后容易复发.

Surgical treatment of spheno - orbital meningiomas: a clinical review of 18 cases

Objective To investigate the effect and follow - up outcome of transcranial approach for spheno - orbital meningiomas.Method Eighteen cases of spheno - orbital meningiomas were removed through different transcranial approaches including frontal - temporal ( pterional and modified pterional ) approach ( 15 cases),orbital -zygomatic approach( 2 cases) and orbital -zygomatic combined with extended transbifrontal approach( 1 case).The involved sphenoid wing and peri -orbit bone were removed to prevent recurrence.The superior orbital fissure and optic canal were decompressed.The visual function evaluation was performed.The extent of tumor resection was judged by intraoperative finding and postoperative image examination.Results The extent of tumor resection:2 cases were Simpson Grade Ⅰ,6 Grade Ⅱ,8 Grade Ⅲ and 2 Grade Ⅳ.After surgery,proptosis was improved in all patients.Visual function was improved in 13 cases.There was no operation - related death.Tumor recurrence was found in 2 cases.Conclusions Adequate exposure of tumor and bony decompression of related cranial nerves could be achieved from appropriate transcranial approaches,thus could relieve clinical symptoms such as proptosis,visual function disturbance and ocular motor malfunction.Complete surgical resection is difficult to be achieved because of involvement of orbital apex,superior orbital fissure and cavernous sinus.