手术切除前颅底及蝶骨嵴脑膜瘤33例临床体会

目的 探讨前颅底及蝶骨嵴脑膜瘤的手术切除方法 和技巧. 方法 回顾性分析安徽医科大学附属安庆医院神经外科自1998年7月至2008年4月收治的33例前颅底及蝶骨嵴脑膜瘤患者的临床资料,其中手术采用经单侧额下入路4例,双侧额下入路17例,翼点入路5例,改良翼点入路7例. 结果 术中肿瘤全切除30例,次全切除2例,大部分切除1例.术后症状改善28例,但出现偏瘫失语1例,精神症状1例,死亡1例,复发2例. 结论 术前通过影像学检查评估肿瘤的位置及与颅底、血管、神经的关系来选择不同的手术入路,术中精细操作以加强对血管、神经的保护是提高肿瘤全切除率,降低致残率、死亡率和复发率的关键.

Surgical resection of anterior cranial base and sphenoid ridge meningioma: clinical experience with 33 cases

Objective To review the surgical approach and skills of craniotomy for resecting anterior cranial base and sphenoidal ridge meningioma. Methods The clinical data of 33 patients with anterior cranial base and sphenoidal ridge meningioma treated between July, 1998 and April, 2008 were analyzed retrospectively. The meningioma was resected via the unilateral subfrontai approach in 4 cases, via the bilateral subfrontal approach in 17 cases, via the pterion approach in 5 cases and via modified ptetion approach in 7 cases. Results Total resection of the meningioma was achieved in 30 cases, subtotal resection in 2 cases and partial resection in 1 case. The clinical symptoms were improved after the operation in 28 cases. One patient showed paralytic aphonia, 1 developed hemiplegia, 1 had psychiatric symptom, 1 died and 2 experienced tumor relapse after the operation. Conclusion The selection of appropriate surgical approach according to the location of the tumor in relation to the skull base, blood vessels and nerves before the operation, careful operation and protection of the blood vessels and nerves during the operation are crucial to reduce the rate of disability, mortality and tumor recurrence following surgical resection of anterior cranial base and sphenoidal ridge meningioma.