大型前床突脑膜瘤的外科治疗经验

目的探讨前床突区手术临床应用解剖,提高前床突区肿瘤的治疗效果。方法回顾性总结1998-2004年收治的采用前外侧硬脑膜外入路手术的前床突脑膜瘤12例,其中视力减退者10例,头痛者11例。采用眶上翼点联合入路,肿瘤累及海绵窦者采用额颞眶颧联合入路。磨除前床突。硬脑膜外阻断肿瘤基底部血供。硬脑膜下切除肿瘤。结果本组患者全切除8例,次全切除3例,部分切除1例。全组无手术死亡。术前视力明显减退的10例患者,术后6例明显好转,2例改善,1例无变化,1例较术前恶化,其中术后视力无改变和视力恶化的2例均为术前有明显视神经萎缩的患者。结论前床突脑膜瘤采用前外侧硬脑膜外入路,磨除前床突,有利于肿瘤基底部的血供阻断以及前床突下肿瘤与颈内动脉的分离。眶上翼点联合入路可明显减小手术对脑组织的牵拉,有利于大型肿瘤上极的显露。

Experience of resection large clinoidal meningiomas

Objective To investigate the clinical applied anatomy in the region of anterior clinoid process, and to improve the therapeutic efficacy of clinoidal tumors. Methods Twelve patients with large meningiomas located in clinoid were surgically treated via the extended anterior and middle fossa combined with epidural approach between January 1998 and August 2004. The surgical outcome and follow-up results were reviewed retrospectively. Supraorbital-poterional approach and cranioorbital zygomatie approach were used when tumors involved cavernous sinus. Anterior clinoid process was grinded with high-speed drilling. Supply of tumors were blocked extradurally. Tumors were resected intradurally. Results Of the 12 cases in large meningiomas located in clinoid, 8 cases had total removal of tumors, 3 patients had subtotal removal. Of the 10 patients with pre-operative severe visual deterioration, 6 patients was markedly improved, one patient unchanged and one patient worsened post-operatively. No death was found in this group. Conclusions Using epidural approach for clinoidal meningiomas and grinding anterior clinoid process was advantageous to block tumors base blood supply and detach infraclinoidal tumors from internal carotid artery. Supraorbital-pterional approach could minimize brain retraction and was advantageous to expose superior pole of giant tumors.