蝶骨嵴内侧型脑膜瘤手术并发症的原因分析

目的寻找蝶骨嵴脑膜瘤手术并发症的原因及降低手术并发症的办法。方法对经手术治疗的56例蝶骨嵴脑膜瘤患者进行了回顾性研究，分析了手术前、后影像图片、手术录像等临床资料。通过MRI检查显示，内侧型37例，直径3．5～7cm；中间型5例，直径3．8～5．2cm；外侧型14例，直径3．8～7．5cm。结果56例患者中，中间型、外侧型的19例患者的肿瘤全被切除，无手术并发症。内侧型肿瘤2例因面神经走行不熟悉及皮瓣过度牵拉将其损伤，7例（暂时5例）动眼神经和1例滑车神经因分离牵拉及手术操作不当损伤，2例因过早切断与肿瘤相关血管损伤大脑中动脉，2例因过分分离侧裂损伤豆纹动脉，1例由于勉强切除浸润颈内动脉的肿瘤而造成其损伤。结论预测不同患者可能出现局部解剖关系的变化和手术中可能出现的困难，结合手术中的具体情况，运用良好的手术技巧，可以减少蝶骨嵴内侧型肿膜瘤手术严重并发症的发生。

Analysis of the causes of surgical complications of medial sphenoidal ridge meningioma

Objective To find out the causes of severe surgical complications of sphenoidal ridge meningioma of and the methods to avoid them. Methods The clinical data of 56 cases of sphenoidal ridge meningioma, 37 being medial(clinoidal)type, 5 being middle(alar)type, and 14 being lateral (pterional) type, with the diameters of 3.5-7 cm, 3.8-5.2 cm, and 3.8-7.5 cm respectively, who underwent operation. Results The tumors of 19 cases of lateral and middle types were resected completely without surgical complication. Facial nerve injury occurred in 2 cases of medial type because of failure to know well the course of facial nerve and over-stretching of skin flap. Oculomotor nerve injury occurred in 7 cases, 5 of which were transient, and trochlear nerve injury occurred in 1 case, all caused by inappropriate manipulations. Too early resection of tumor-related vessel caused middle cerebral artery injury in one case. Resection of the tumor infiltrating the carotid artery inadequately caused injury of the carotid artery. Lenticulostriate artery injury was caused in 2 cases by over-separation of the lateral fissure. Conclusion Severe surgical complications can be avoided if the surgeons, with great skills, are able to predict different topographic changes and difficulties encountered during operation in the light of the specific conditions in operation.