嗅沟脑膜瘤的显微外科治疗

目的 探讨进一步提高嗅沟脑膜瘤治疗效果的有效方法.方法 应用显微神经外科技术治疗嗅沟脑膜瘤67例,其中首次发病57例,复发8例,二次复发2例.术中采用改良Derome入路12例,双侧额底入路28例,改良翼点入路21例,单侧额底入路6例.肿瘤切除包括附着硬膜、肿瘤基底增生破坏的骨质以及受累的副鼻窦黏膜,最后对缺损颅底做修补重建.结果 按照脑膜瘤切除的Simpson分级标准,肿瘤获Simpson Ⅰ类切除59例,Ⅱ类切除7例,Ⅳ类切除1例.术后并发脑脊液漏和颅内感染仅1例,经处理治愈.术后1个月内死亡2例(2.9%),死因分别为心衰和下丘脑损伤.47例(72.3%)患者随访1～10年,平均64个月.2例高龄患者死亡,其中1例死于肺炎,1例死因不详.45例生存患者中,复发3例,为Ⅱ类或Ⅳ类切除者,Ⅰ类切除者均无复发.除3例患者仍存在视力下降和2例患者一侧肢体轻瘫外,其余患者恢复良好,已恢复工作或能生活自理.结论 全切除肿瘤(Simpson Ⅰ类)应是嗅沟脑膜瘤的手术目的,特别是新发的病例.选择适当的手术入路是全切除肿瘤的根本保证.采用适当的带血管蒂材料修补、重建前颅底是手术治疗嗅沟脑膜瘤至关重要和必须做到的.

Abstract：

Objective To explore an effective method for further improving the surgical results of treatment of olfactory groove meningiomas.Methods Sixty seven cases of olfactory groove meningiomas were treated by microneurosurgery, among which fifty seven were de novo cases, eight were recurrent tumors and the other two re-recurrent cases.Modified Derome approach was used in 12 cases, bilateral subfrontal approach in 28 cases, modified pterional approach in 21 cases and unilateral subfrontal approach in six cases.Tumors were resected microsurgically with radical removal of invaded dura, bone, and paranasal sinus mucosa.Reconstruction was performed in patients with skull base defect.Results Simpson grade Ⅰ removal was accomplished in 59 cases, grade Ⅱ in seven cases and grade Ⅳ in one case.Among 57 patients with de novo tumor, Simpson Ⅰ resection was accomplished in 54 cases.Postoperative rhinorrhea and intracranial infection occurred in one case and was cured after temporal lumbar CSF drainage and antibiotic therapy.Two patients ( 2.9% ) died within one month after operation, i.e.one aged patient of heart failure and the other of severe hypothalamus complication.Forty seven patients(72.3% ) were followed up from one to ten years with an average of five years and four months.With the exception of two cases died,among the alive 45 patients, there were only three patients with tumor recurrence, which had undergone Simpson Ⅱ or Ⅳ tumor resection.No recurrence was found in cases with Simpson Ⅰ tumor removal.Previous blurred vision was not improved in three patients, hemiparalysis in two patients, and the other patients recovered well, resuming previous jobs or being able to take care themselves.Conclusions Total tumor removal ( Simpson Ⅰ ) should be the surgical goal for treatment of olfactory groove meningiomas,especially for de novo cases.An appropriate approach is fundamental in the effort to remove an OGM totally.Appropriate anterior skull base reconstruction with vascularized material is important and mandatory.

Microsurgical removal of olfactory groove meningiomas

Objective To explore an effective method for further improving the surgical results of treatment of olfactory groove meningiomas.Methods Sixty seven cases of olfactory groove meningiomas were treated by microneurosurgery, among which fifty seven were de novo cases, eight were recurrent tumors and the other two re-recurrent cases.Modified Derome approach was used in 12 cases, bilateral subfrontal approach in 28 cases, modified pterional approach in 21 cases and unilateral subfrontal approach in six cases.Tumors were resected microsurgically with radical removal of invaded dura, bone, and paranasal sinus mucosa.Reconstruction was performed in patients with skull base defect.Results Simpson grade Ⅰ removal was accomplished in 59 cases, grade Ⅱ in seven cases and grade Ⅳ in one case.Among 57 patients with de novo tumor, Simpson Ⅰ resection was accomplished in 54 cases.Postoperative rhinorrhea and intracranial infection occurred in one case and was cured after temporal lumbar CSF drainage and antibiotic therapy.Two patients ( 2.9% ) died within one month after operation, i.e.one aged patient of heart failure and the other of severe hypothalamus complication.Forty seven patients(72.3% ) were followed up from one to ten years with an average of five years and four months.With the exception of two cases died,among the alive 45 patients, there were only three patients with tumor recurrence, which had undergone Simpson Ⅱ or Ⅳ tumor resection.No recurrence was found in cases with Simpson Ⅰ tumor removal.Previous blurred vision was not improved in three patients, hemiparalysis in two patients, and the other patients recovered well, resuming previous jobs or being able to take care themselves.Conclusions Total tumor removal ( Simpson Ⅰ ) should be the surgical goal for treatment of olfactory groove meningiomas,especially for de novo cases.An appropriate approach is fundamental in the effort to remove an OGM totally.Appropriate anterior skull base reconstruction with vascularized material is important and mandatory.