鞍结节脑膜瘤显微手术治疗策略

目的探讨鞍结节脑膜瘤的显微手术切除策略。方法回顾性分析82例鞍结节脑膜瘤的临床资料,均采用显微手术切除。经额外侧入路44例,经眶-额外侧入路28例,经眶-颧-额-颞入路7例,经翼点入路3例。术中磨除前床突和视神经管顶及外侧嵴,切除侵入视神经管内的肿瘤27例;磨除鞍结节,经蝶窦切除鞍前壁肿瘤12例。结果肿瘤SimpsonⅠ、Ⅱ级切除75例(91.5%),SimpsonⅢ级切除7例(8.5%);术后视力改善和稳定151只眼(92.1%),视力恶化13只眼(7.9%)。术后出现不同程度下丘脑症状2例,术后偏瘫1例,无手术死亡病例。结论正确选择手术入路,采用熟练的显微颅底外科技术是获得良好手术效果的保证。额外侧入路能提供良好的手术空间和视野,术后视觉症状改善明显。术中打开视神经管,仔细辨别并保护蛛网膜屏障中的小血管,是保障肿瘤全切除和术后视力恢复的关键。

The strategy of microsurgical treatment for tuberculum sellae meningioma

Objective To explore the strategy for removing tuberculum sellae meningiomas.Methods Clinical data of 82 patients with tuberculum sellae meningiomas were analyzed retrospectively.The tumors were microsurgically removed in 44 patients via frontal lateral approach,28 via orbital-frontal lateral approach,7 via frontotemporal orbitozygomatic approach and 3 via pterional approach.The anterior clinoid processand,roof and lateral crista of the optic canal were strippinged to excise tumors invading into optic canal in 27 cases;tuberculum sellae was stripped to excise the tumors in the anterior wall of the saddle through the sphenoidal sinus in 12 cases.Results Removal of Simpson Grade Ⅰ,Ⅱ was performed in 75 cases （91.5 %）,removal of Simpson Grade Ⅲ in 7 cases （8.5%）.Postoperatively,the visual acuity was improved or maintained stable in 151 eyes （92.1 %）,while 13 eyes deteriorated （7.9 %）.Different symptoms of the hypothalamus occurred in 2 cases,hemiplegia occurred in 1 case.There was no mortality.Conclusions Right surgical approach and proficient skull base surgical technique can assure an effective surgery.Frontal lateral approach could provide a better surgery space and surgical field for removing tuberculum sellae meningiomas,with a significant visual improvement.Intraoperative distinguishing and protection of small vessels in the blood-retinal barrier in the optic canal is the key of total tumor resection and recovery of visual acuity.