显微手术治疗蝶骨嵴脑膜瘤的探讨

目的 探讨蝶骨嵴脑膜瘤的手术方法 与技巧.方法 对蝶骨嵴区域的显微解剖、蝶骨嵴脑膜瘤的血液供应和手术技巧进行研究并应用于35例蝶骨嵴脑膜瘤的手术中.结果 (1)翼点入路能较好地显露鞍区前部的解剖结构;额颞颧入路可较多地显示中颅窝和鞍区后部的解剖结构;额颞眶颧入路对海绵窦的显露具有优势.(2)蝶骨嵴脑膜瘤血液供应可分三种类型:单纯颈外动脉供血,颈外、颈内动脉双重供血和单纯颈内动脉供血.(3)全切除蝶骨嵴脑膜瘤29例(Simpson Ⅰ、Ⅱ),次全切除6例.死亡2例.结论 熟练掌握颅底解剖、神经介入和显微外科技术,可明显提高蝶骨嵴脑膜瘤的全切率,减少致残率和死亡率.

The exploration of microsurgical treatment of the sphenoid meningioma

Objective To discuss the surgical skills of the sphenoid meningiomas.Method The anatomy,the blood supply of sphenoid region and the surgical skills were studied.35 cases with the sphenoid meningiomas who underwent mierosurgery were analyzed retmspoctively.Results (1)The pterional approach provides an optimal exposure to the anterior sellar region.The frontotemporal-zygomatic approach provides a favorable exposure to the middle fossa and parasellar region.The frontotemporal orbitozygomatic route provides a wide angle of exposure to the contents of the inferior frontal lobe,parasellar region,cavernous sinus,interpeduncular cisterns,and floor of the anterior and middle fossa.(2)There are 3 types of the blood supply of the sphenoid meningiomas:supply by the external carotid artery,supply by the external carotid anery and the internal carotid artery,and supply by the internal carotid artery.(3)The tumors were totally removed in 29 cases,and the others were subtotally removed,with 2 cases of death.Conclusions With extensive understanding of the neuroanatomy,progression of the interventional therapy and the surgical techniques,the sphenoid meningiomas can be radically and safely resected with less morbidity and mortality.