显微手术治疗鞍区脑膜瘤32例报告

目的:探讨鞍区脑膜瘤的诊断、手术入路、显微手术切除的操作技术及预后。方法:采用CT及MRI扫描检查和显微外科技术,对32例鞍区脑膜瘤行手术切除,瘤体最大径为3~6cm,其中单侧额下入路切除13例,采用翼点或扩大翼点入路切除19例。结果:肿瘤全切除(Simpson、)27例,次全切除5例,无手术死亡。术后颅高压症状均缓解,18例有视力视野障碍者,改善15例,无改变3例。结论:对于鞍区脑膜瘤向鞍上前方、上方、鞍内甚至向蝶窦内生长者,可以采用单侧额下经纵裂入路;而对于向侧方或后方生长的鞍区脑膜瘤,可采用翼点或扩大翼点入路,两者均能获得良好的肿瘤暴露,全切除率较高。

Microsurgical management of sellar area meningioma

Objective:To summarize microsurgical approaches and patient's outcome of sellar area meningiomas. Methods: 32 patients with meningioma which originates from tuberculum sellae or diaphragma sellae or internal sphenoidal ridge have been operated on by unifrontal basal interhemispheric approach or enlarged pterion approach. The degree of tumor resection and the patient's outcome were discussed. Results: Total resection (SimpsonⅠ,Ⅱ)had been performed on 27 patients, the other 5 patients were processed by subtotal resection, with no death perioperatively. After operation, the intracranial hypertension was relieved,and 15 of 18 patients who had disturbance in visual acuity and visual field were obviously improved ,other 3 had no change . Conclusion: Unifrontal basal interhemispheric approach or enlarged pterion approach can treat nearly all the meningiomas in sellar region. Both of the approaches can obtain good esposure. The total incised rate is higher.