侧脑室脑膜瘤的诊断与显微手术治疗

Diagnosis and treatment of microneurosurgery for meningiomas of the lateral ventricle.

目的 探讨侧脑室脑膜瘤的诊断及其显微外科手术治疗。方法 回顾性分析 5年间 2 4例侧脑室脑膜瘤的临床手术资料 ,肿瘤大小 2cm× 1 5cm× 1 5cm～ 9cm× 7 5cm× 7cm。全部病例均行CT和 /或MRI检查 ,6例行脑血管造影。手术采用顶枕入路 15例、颞上中回入路 9例。结果 2 4例均获肿瘤全切 ,其中 3例完整切除 ,2 1例分块切除。无手术死亡。术后发生术区血肿 2例 ,行二次手术清除血肿 ;脑室炎 4例 ,失语 2例 ,对侧肢体轻瘫 3例 ,均经积极处理好转出院。术后随访半年～ 5年 ,未见复发。结论 CT、MRI对侧脑室脑膜瘤的诊断具有重要价值。侧脑室脑膜瘤均应手术治疗 ;充分的术前准备、良好的手术入路与暴露、应用显微外科技术、保护肿瘤周围组织结构、牢靠止血、管理好术后引流是全切肿瘤。

Objective To discuss the diagnosis and treatment of microneurosurgery for meningiomas of the lateral ventricle.Methods A retrospective analysis was performed on 24 patients with meningomas of the lateral ventricle during a 5-year period.The tumor size ranged from 2cm×1.5cm×1.5cm to 9cm×7.5cm×7cm.Eighteen patients were examined with CT,two cases with MRI,four cases with CT and/or MRI.All patients underwent microneurosurgical operative therapy through parieto-occiptical (15cases)and posterior transtemporal approach(9 cases).Results Twenty-four cases had total tumor removal.There were no postoperative deaths.The follow-up period ranged from 0.5 to 5 years.All followed patients have been doing well.Conclusion CT and MRI is important for the diagnosis of the meningoma of the lateral ventricle.Total resection of the tumors can be obtained by microneurosurgery.Sufficient preoperative preparation,adequate surgical approach and exposure,effective management of operative bleeding,and avoidance of damage to the brain tissues are the important factors to improve the rate of surgical resection and overall outcomes with meningomas of the lateral ventricle.