蝶骨嵴内侧脑膜瘤术后并发症相关因素分析

Risk factor for postoperative complications in patients with medial sphenoid ridge meningioma

目的 探讨蝶骨嵴内侧脑膜瘤(mSWM)术后并发症的相关因素。方法 回顾性分析2011年1月至2021年1月经翼点入路或扩大翼点入路手术治疗的129例mSWM的临床资料。术后并发症定义为术后6个月仍存在神经功能障碍,如肢体偏瘫,外展神经麻痹,动眼神经麻痹,复视,视力下降,脑积水,意识障碍,癫痫发作,颅骨缺损等。结果 129例中,术后6个月存在并发症20例,并发症发生率为15.50%(20/129);一侧肢体偏瘫4例,术后因颅内血肿致意识障碍2例,动眼神经损伤3例,外展神经损伤3例,因术后脑梗死行去骨瓣减压术遗留颅骨缺损2例,术后发生癫痫大发作4例,视力下降2例。多因素logistic回归分析显示,肿瘤侵犯海绵窦(OR=4.205;95%CI 1.104~16.019;P=0.035)、肿瘤包绕颈内动脉或其分支(OR=3.501;95%CI 1.054~11.631;P=0.041)是m SWM术后发生并发症的独立危险因素。结论 对于侵犯海绵窦、包绕颈内动脉或其分支的m SWM,单纯追求肿瘤的全切除,会提高并发症的发生率,适当保留少量肿瘤,术后辅以放疗,可能是更好的选择。

Objective To investigate the risk factor for postoperative complications in patients with medial sphenoid ridge meningioma(mSWM). Methods The clinical data of 129 patients with m SWM who underwent surgical treatment from January 2011 to January 2021 were analyzed retrospectively. Postoperative complications included neurological dysfunction 6 months after surgery, such as limb hemiplegia, abducens nerve palsy, oculomotor nerve palsy, diplopia, decreased vision, hydrocephalus, disturbance of consciousness, seizures, and skull defect. Results Of 129 patients, 20 patients suffered from postoperative complications 6 months after operation, and the complication rate was 15.50%. Limb hemiplegia occurred in 4 patients, postoperative disturbance of consciousness due to intracranial hematoma in 2, oculomotor nerve injury in 3, abducens nerve injury in 3, skull defect due to postoperative cerebral infarction in 2, postoperative seizures in 4, and vision loss in 2. Multivariate logistic regression analysis showed that the tumor invading the cavernous sinus(OR=4.205;95% CI 1.104~16.019;P=0.035) and the tumor surrounding the internal carotid artery and its branches(OR=3.501;95% CI 1.054~11.631;P=0.041) were independent risk factors for postoperative complications in the patients with mSWM.Conclusions For mSWM that invades the cavernous sinus and surrounds the internal carotid artery and its branches, simply pursuing total tumor resection will increase the incidence of complications. Appropriately retaining a part of tumor and supplemented by postoperative radiotherapy may be a better choice.