前颅底及颅鼻眶沟通脑膜瘤切除及颅底重建探讨

目的探讨显微手术切除前颅底脑膜瘤的手术入路选择以及颅底重建的适应证。方法经头颅CT或MRI扫描确诊,据肿瘤大小、部位选择不同的入路,显微镜下切除肿瘤并行颅底修复重建。本组颅底脑膜瘤110例,经额颞眶颧联合入路切除35例,经额鼻筛眶入路38例,经翼点入路切除4例,经冠状开颅切除33例。结果镜下全切除肿瘤88例,次全切除17例,大部分切除5例。临床痊愈85例,好转23例,死亡2例。随访79例,肿瘤复发5例,行第二次手术切除,死亡5例,余恢复良好。结论根据肿瘤的大小、部位选择不同的手术入路,显微镜下切除前颅底脑膜瘤及必要时颅底修复重建是一种安全、有效的治疗方法。

Microsurgical Resection of Anterior Cranial Base Meningiomas and Reconstruction of Cranial Base

Objectives To explore the operative technique and approach of surgical treatment of anterior cranial base menin-giomas, such as cranioorbital meningiomas, cranionasoorbital meningiomas and sphenoidal ridge meningiomas, and indication of cranial base reconstruction. Methods One hundred and ten cases of the anterior cranial base meningiomas were definitely dignosised by CT and/or MRI. According to their size and site, the different operative approaches were chosen to remove the tumors under a microscope. The cranial base reconstruction was performed in some patients of 110 cases of anterior cranial base meningiomas, of which, 35 were removed through the combined fronto-temporo-orbito-zygomatic approach, 38 through the fronto-naso-ethmo-orbital approach, 4 through the pterional approach and 33 through the crowed craniotomy. Results The tumors were totally removed under a microscope in 88 patients, subtotally in 17 and partly in 5 of 110 patients with anterior cranial base meningiomas. Of 110 patients, 85 were clinically cured, 23 improved and 2 died. Of 79 patients followed up, 5 with recurrent tumors were cured by reoperation, 5 died and the others became better. Conclusion The microsurgical resection of the tumors through different approaches based on the size and site of the tumors is a good method to treat the anterior cranial base meningiomas, but the reconstruction of cranial base is necessary in some patients.