小脑幕脑膜瘤的手术治疗

目的 探讨小脑幕脑膜瘤的手术入路和手术技巧。方法 对1992年1月至2002年12月间收治的小脑幕脑膜瘤进行回顾性分析。本组56例，占同期收治的所有颅内脑膜瘤的8．66％，女性占绝大多数。对主要向幕上发展者，根据肿瘤的部位，采用扩大翼点入路、颢下入路、颞枕部入路和枕部入路；肿瘤全部或主体在后颅窝者，采用枕下或枕部-枕下联合开颅术；跨幕者采用颞下-乙状窦前入路。结果 本组全切除53例，部分切除3例，术后死亡2例(3．6％)，出现新增神经功能障碍5例，复发6例。结论 小脑幕脑膜瘤手术入路的选择必须根据患者的具体情况进行个体化设计；熟悉局部的显微解剖并熟练运用显微外科技术是取得手术成功的关键。

Surgical treatment of tentorial meningiomas

Objective The present article aims at exploring the surgical approaches and techniques for tentorial meningiomas . Methods 56 patients with tentorial meningiomas who were operated on between 1992 and 2002 were retropectively analysed. These cases represented 8.66% of all intracranial meningiomas operated on in that period. They predominate in women. The tumors with mainly supratentorial development were approached with modified pterional,subtemporal,temporooccipital or occipital craniotomy. For tumors developing mainly in the posterior cranial fossa, suboccipital craniectomy or combined occipital- suboccipital craniectomy was performed. The tumors with both supratentorial and infratentorial development were approached by using a subtemporal-presigmoidal craniotomy. Results Total removal was achieved in 53 cases and partial removal in 3 cases. Two cases died of severe postoperative complications.Our mortality rate was 3.6%. Five had additional neurological deficits postoperatively. Recurrences occurred in 6 cases. Conclusion The choice of approach to tentorial meningiomas must be specifically individualized in each case. The surgeon must know well about microanatomy of the tentorium and its surrounding structures and expertly use microsurgical techniques in order to perform a successful surgery and to obtain a good outcome.