前纵裂入路显微手术治疗鞍结节脑膜瘤

目的:探讨前纵裂入路切除鞍结节脑膜瘤的手术技术以及安全性有效性,特别关注术后视力的变化。方法:回顾性分析新疆医科大学第一附属医院神经外科2005年1月～2010年12月连续收治的21例前纵裂入路切除鞍结节脑膜瘤患者的临床资料。前纵裂分离时在显微镜高倍放大视野下锐性逆向分离,且要分离足够开,从大脑前动脉膝部至蝶骨平台,必要时可同时在第一间隙和第四间隙操作切除突入三脑室底的肿瘤,而不牵拉视交叉和三脑室底。肿瘤切除从中线开始,先分离阻断肿瘤基底部血供,蛛网膜内瘤内分块切除减压,分离肿瘤和神经之间的蛛网膜界限,依次分离视力较差侧、视交叉、视力较好侧,最后分离垂体柄以及脚尖窝的肿瘤,注意保护蛛网膜界限完整。评价术前、术后视力变化以及肿瘤是否全切。结果:随访3个月～58个月,肿瘤全切19例(SimpsonⅡ级),1例复发。2例大部切除。21例病人中,视力好转15例,没有变化5例,1例恶化。2例额叶静脉梗塞性出血。结论:尽管病例数较少,随访时间也较短,本研究结果基本可以说明前纵裂入路切除鞍结节脑膜瘤是安全有效地。

Anterior Interhemispheric Approach to Treat Tuberculum Sellae Meningioma with microsurgery

OBJECTIVE:To retrospectively analyze patients with TSM who underwent surgery via an anterior interhemispheric approach,with special attention to visual outcomes.METHODS:Twenty-one consecutive patients between January 2005 and December 2010 were examined.Visual acuity was sequentially evaluated in the pre and postoperative periods all tumors were removed via an anterior interhemispheric approach.Following the wide dissection of the interhemispheric fissure,the tumor was first detached from its origin and debulked at the midline.The debulking continued until the arachnoid plane separating the nerve and tumor was visualized.RESULTS:Gross total resection(Simpson II) was achieved in 19 patients.Among 21 patients,15 patients had an improvement of the visual acuity after surgery.Visual acuity was unchanged in 5 pa-tients,and one patients experienced visual deterioration.Other nonvisual complications,frontal lobe venous infarction occurred in 2 patients.CONCLUSION:Despite the small number of patients,a high resection rate and favorable visual outcome support the suitability of this approach for resection of TSM.