鞍结节脑膜瘤显微外科手术入路选择与临床分析

目的探讨不同部位和大小的鞍结节脑膜瘤显微手术入路和手术结果。方法回顾分析安徽省立医院神经外科自2002年01月至2011年07月鞍结节脑膜瘤49例,采用5种不同的手术入路,采用显微外科技术手术切除。分析全切除率、手术效果和并发症发生的情况。结果经单侧额下入路18例,经冠状开颅额下入路15例,冠状开颅前纵裂入路7例,眶上锁孔入路5例,翼点或改良翼点入路4例。肿瘤切除程度按Simpson分级评估,达SimpsonII级切除者40例,III级切除者9例,肿瘤全切除率(Simpson II级)为81.6%。本组1例死亡病例,死亡原因考虑术前患者即肿瘤卒中昏迷,术后致多脏器衰竭。术前38例合并视力减退及视野缺损,术后视力较术前明显改善20例,无明显变化17例,视力加重1例。结论显微手术是治疗鞍结节脑膜瘤的主要手段,手术入路选择应根据:①肿瘤的生长方式,肿瘤的大小。②术前视力视野受累程度。③术者习惯。④手术路径最短,对脑组织损伤最小。手术疗效取决于:术前视力受累程度,病程的长短,术中对神经、血管和脑组织的保护,肿瘤全切除率等。

Microsurgical treatment and clinical effect of tuberculum sellae and diaphragm sellae meningiomas

Objective To explore the microscopic surgical approach and efficacy in surgery of tuberculum sellae meningioma with different position and size.Methods A retrospective analysis was made on 49 cases of tuberculum sellae meningioma operated from Jan,2002 to July,2011 in department of neurosurgery of Anhui provincial hospital which all removed by using microsurgical technique with five different surgical approach.The removal rate,surgery effect and complications were analysed.Results According to the Simpson grade,grade II was achieved in 40 cases,grade III was 9 cases.The resection rate(Simpson level II) was 81.6%.During all the cases,1 death was occurred which may result from tumor apoplexy before the surgery and postoperative multiple organ failure(MOF).38 patients were with merger ision loss and visual field defects preoperate,and 20 cases were improved obiviously after surgery,17 case with no manifest change,and 1 case aggravated.Conclusion Microscopic surgery is the main way of remove tuberculum sellae meningioma and the surgical approach should be chosed according to the following 4 points: ①the growth pattern of tumor and the size;②degree of eye vision;③the habit of surgeon;④surgery time and brain damage.The efficacy of surgery mainly based on the degree of eye vision,length of disease course,protection of nerve,vessels and tissue during the operation,and finally,the removl rate,etc.