颅底中线区大型和巨大型脑膜瘤的显微手术切除

目的探讨颅底中线区不同部位大型和巨大型脑膜瘤手术入路和切除方式,并分析特殊类型脑膜瘤手术治疗方法。方法本组93例,男性26例,女性67例;平均年龄48.4岁。术前行神经影像学检查,根据肿瘤部位,选择相应手术入路,采用显微手术切除肿瘤。结果肿瘤全切除80例(86.02%),大部分切除13例(13.98%),死亡1例(10.75%)。除单条颅神经功能术前完全丧失外,术后神经功能改善者75例(81.52%),不变者10例(10.86%),加重者7例(7.6%)。经6月￣7年随访,13例(14.13%)肿瘤复发。结论颅底中线区大型和巨大型脑膜瘤手术切除难度大。要取得良好的手术效果,必须选择正确手术入路,采用分块切除方式,精心保护重要血管和神经。

Microsurgical resection of large and huge meningiomas in median line region of skull base

Objective To explore the operative approach and mode for resecting large and huge meningiomas in median line region of skull base and to analyze the operative strategy of the special meingioma. Methods Ninety-three patients (male 26, female 67, average age 48.4 years) were enrolled in the study. Based on the tumor location determined with CT and/or MRI before operation, a suitable approach was selected for microsurgical resection of tumor. Results Total removal was achieved in 80 (86.02%) cases and partial removal in 13 (13.98%). One patient (10.75%) died postoperatively. Nervous function evaluation showed the improvement in 75(81.52%) cases, no significant change in 10(10.86%) and deterioration in 7(7.6%), except a cranial nerve having completely lost function before operation. Follow-up ranging from 6 months to 7 years revealed the tumor recurrence in 13 (14.13%) cases. Conclusion Although it is very difficult to remove the large or huge tumors in the median line region of skull base, a good outcome can be obtained in such situations as the correct choice of a suitable operative approach, the piecemeal removal of tumor, and the protection of important vessels and nerves.