显微手术治疗颅底脑膜瘤23例分析

目的 探讨显微手术治疗颅底脑膜瘤的手术入路和操作要点.方法 选取本院收治行显微切除术的颅底脑膜瘤患者46例,随机分为观察组和对照组各23例;观察组以多螺旋CT和MRI对瘤体的解剖位置和血供走向作综合分析,分别选择额下、翼点、枕下等手术入路切除,对照组统一采取枕下乙状窦后入路;对比分析2组手术疗效,总结手术技巧.结果 除小脑桥脑角脑膜瘤外,观察组手术时间和术中出血量均显著少于对照组（P〈0.05）.观察组全切除19例,其中SimpsonⅠ级14例,SimpsonⅡ级5例,次全切除4例;对照组全切除12例,其中SimpsonⅠ级10例,SimpsonⅡ级2例,次全切除11例;观察组全切率显著高于对照组（P〈0.05）.观察组术后并发症发生率13.0%,显著显著低于对照组的43.8%（P〈0.05）.结论 颅底脑膜瘤解剖位置深,血供丰富,手术入路应以最大限度显露手术视野和最低程度减少脑组织牵拉为原则,尽可能接近颅底病变区域;在此基础上,精确掌握瘤体与周边组织的解剖关系,谨慎操作,避免医源性血管和神经损伤,是手术成功的关键.

Microsurgical treatment for 23 cases with skull base meningiomas

Objective To investigate the best operative approach and key points of microsurgery for skull base meningiomas. Methods Forty-six cases of patients with skull base emningiomas in our hospital treated with microscopic resection were randomly divided into two groups. Twenty-three cases of observation group were examined with spiral CT and MRI to assess the anatomic location and blood supply of tumor in order to choose the best operative approach for tumor resection, while 23 cases of control group were all operated by retrosigmoid approach. Curative effect was contrastively analyzed to summarize the operation skills after surgery. Results In addition to cerebellopontine, the operative time and blood loss in observation group were all significantly less than that in control group （P〈0.05）. There were 19 cases of total resection with 14 cases of Simpson I and 5 cases of Simpson II , and 4 cases of subtotal resection in observation group; while there were 12 cases of total resection with 10 cases of Simpson I and 2 cases of Simpson II , and 11 cases of subtotal resection in control group;which total re- section rate was significantly lower （P〈0. 05）. Further more, there was also less complications in observation group compared to control group （P〈0.05）. Conclusion The research result shows that it is feasible to choose the nearest operative approach for the microsurgery of skull base meningiomas in consideration of its deep anatomical position and rich blood supply, on the base of which the accurate grasp of tumor structure and carefully operation are also needed to avoid iatrogenic vascular and nerve injury.