显微手术切除颅内大型脑膜瘤

Resection of Large Intracranial Meningioma using Microsurgical Technique

脑膜瘤是常见的颅内良性肿瘤,治疗以手术切除为主,本文总结我们收治的大型、巨大型脑膜瘤的影像学特点以及显微外科技术方法,提高肿瘤的手术切除率,降低死亡率的体会。方法:总结分析我院神经外科2000年5月～2002年10月采用显微外科手术切除21例颅内各部位脑膜瘤的治疗经验。大脑半球凸面脑膜瘤6例,大脑镰旁脑膜瘤5例,矢状窦旁脑膜瘤4例,中颅窝底脑膜瘤3例,后颅窝桥小脑角脑膜瘤2例,蝶骨嵴脑膜瘤1例,其中大型脑膜瘤13例,巨大型6例,脑深部脑膜瘤2例。结果:显微手术全切除18例,次全切除3例,无死亡病例。结论:采用微创显微外科手术技术,可提高颅内脑膜瘤的全切除率,减少复发,降低手术死亡率,提高病人手术后生存质量。当肿瘤巨大或肿瘤邻近脑干或重要大血管时,肿瘤全切除困难,应考虑次全切除,术后采用伽玛刀处理残留部分。

[ASTRACT] BACKGROUND & OBJECTIVES: Meningioma is one of the most common benign tumors in central nervous system (CNS), surgical resection is the most important treatment. In this paper, we summarized the radiological features and the microsurgical techniques used in treatment of intracranial large or huge menin-giomas in our hospital. Our experience on how to increase the extent of resection and how to reduce operative motali-ty are shared. METHODS: Twenty-one intracranial meningiomas surgically treated in our department from May 2000 to Oct. 2002 were retrospectively reviewed. Tumor locations were convexity in 6 cases, parafalceal in 5,parasagittal in 4, middle cranial fossa in 3, cerebellopontine angle in 2, and sphenoid wing in 1. Thirteen were classified as large, 6 were huge, and 2 were deep-seated. RESULTS: Microsurgical technique were used in all 21 patients. The tumors were totally removed in 18 cases; while 3 cases were subtotally resected. There was no mortality in this series. CONCLUSION: Using microsurgical technique, we can improve total resection of the tumor and minimize mortality and recurrence. Hence, quality of life of the patients is improved. It is wise to per-form subtotal resection for tumors located in vital area when total resection is impossible. The residual tumour can be treated with radiosurgery.