颅底脑膜瘤的显微手术体会

目的 探讨提高颅底脑膜瘤全切率、降低死亡率和致残率的显微外科手术技巧。方法 本组61例颅底脑膜瘤，根据肿瘤部位分别采用不同的手术入路进行手术，手术入路包括双（单）侧额下入路，翼点或改良及扩大翼点入路，幕上枕下、幕下小脑上或幕上下联合入路，枕下乙状窦后入路，经岩骨乙状窦前入路，枕下入路，远外侧入路等。结果 肿瘤切除达到SimpsonⅠ-Ⅱ级全切除54例，次全切除4例，大部切除3例。术后早期发生颅神经麻痹11例，无手术死亡。结论 通过合适的手术入路，依靠娴熟的显微外科技术和先进手术设备，积极而谨慎地切除颅底脑膜瘤可以取得满意效果。充分暴露。严密止血，正确处理肿瘤与重要组织的关系是手术成功的关键。

Microsurgical Treatment of Meningiomas in Skull Bases

Objective To heighten the rate of total removal of meningiomas in the skull base, and to reduce the mortality and disable rate in the patients with skull base meningiomas. Methods Sixty-one patients with skull base meningiomas were treated by mierosurgery through different operative approaches according to the different regions where the tumors located. Results Of 61 patients with meningiomas, 54 received total removal of the tumors （Simpson＇s grade Ⅰ-Ⅱ）, 4 subtotal and 3 greatly partial. The skull nerve paralysis occurred after the operation in 11 patients. No patients died. Conclusions Good outcome can be achieved by skilful and cautious microsurgery through the proper operative approach in the patients with skull base meningiomas. The key to operative success is a sufficient exposure, accurate hemostasis, right dealing with the relationship between the tumor and important tissue.