鞍结节脑膜瘤的显微外科手术治疗

目的探讨和评价鞍结节脑膜瘤的临床和影像学特点,以及显微外科技术和手术效果.方法回顾性分析本院1985年至2002年手术治疗的鞍结节脑膜瘤41例,分析其临床和影像学表现的特点.根据CT和MR的表现,将其分为大、中、小3型,采用4种不同的手术入路,比较全切除率、手术结果和并发症发生情况.结果鞍结节脑膜瘤的临床特点是早期出现单侧和双侧视力下降,视野改变不典型.MRI特点为明亮均一的增强,肿瘤中心在鞍上,伴基底硬膜尾征,蝶鞍不扩大.肿瘤的全切除率与肿瘤大小有关,中、小型肿瘤全切除率较高.眶上匙孔入路、翼点入路和眶颧入路显露满意和手术效果好,明显优于单侧额下入路.结论鞍结节脑膜瘤早期出现视力下降,以中、小型肿瘤为主.大多数鞍结节脑膜瘤可以完全及安全地切除,小、中型肿瘤宜采用眶上匙孔入路,中、大型肿瘤宜采用翼点侧裂入路,大型肿瘤宜采用眶颧入路切除肿瘤.

Microsurgical treatment of tuberculum sellae meningiomas

Objective To investigate and assess the clinic and imaging features, microsurgical techniques, and operative effect in cases of tuberculum sellae meningiomas. Methods A retrospective analysis of clinical and imaging manifestations was made on 41 cases of tuberculum sellae meningioma from 1985 to 2002. The tumors operated on with 4 different operative approaches were classified into large, middle and small type depending upon its size on CT or MRI, with the comparison of total resection rate, operative results and complications among the types. Results The clinical features of tuberculum sellae meningioma included early occurring visual dysfunction in one eye or both eyes and untypical visual field defects. There was a relationship between total resection rate and size and site of tumors, with a higher rate in middle and small types and anterior tumors. On MRI meningiomas revealed significant homogeneous enhancement with administration of gadolinium, a dural-based tail, a suprasellar epicenter and sella turcica unexpanded. The supraorbital keyhole approach, pterional approach and frontotemporal orbitozygomatic approach were superior to unilateral subfrontal approach, with a list of advantages including satisfactory exposure, little retraction of the frontal lobe, higher resection rate, less postoperative complications and better operative results. Conclusion The visual deficit in the majority of the middle and small type can occurs early, These tumors can be removed completely and safely in many cases. The more appropriate approaches are the supraorbital keyhole approach in small and middle types, the pterional approach in middle and large types and the frontotemporal orbitozygomatic approach in large type.