天幕脑膜瘤的分型和手术入路选择

Classification and surgical approach for tentorial meningiomas

目的 :探讨天幕脑膜瘤的分型和手术入路的选择。 方法 :对 1992年 1月至 2 0 0 2年 12月间收治的天幕脑膜瘤进行回顾性分析 ,并按分型选择不同的手术入路。本组 5 6例 ,其中内侧型 2 8例 ;外侧型 17例 ;镰幕型 11例。对主要向幕上发展者 ,根据肿瘤的部位 ,采用扩大翼点入路、颞下入路、颞枕部入路和枕部入路 ;肿瘤全部或主体在颅后窝者 ,采用枕下或枕部 枕下联合开颅术 ;跨幕者采用颞下 乙状窦前入路 ;镰幕型均采用枕部入路。 结果 :本组肿瘤全切除 5 3例 ,部分切除 3例 ,全组共死亡 2例 (3.6 % ) ,术后出现新增神经功能障碍 5例 ,复发 6例。 结论 :天幕脑膜瘤手术入路的选择必须根据患者的具体情况进行个体化设计 ;

Objective:To explore the classification and the choice of surgical approach for tentorial meningiomas. Methods: 56 patients with tentorial meningiomas operated on between 1992 and 2002 were retrospectively analysed. According to Gkalp , there were 28 cases with medial tumor,17 cases with lateral tumor,11 cases with falcotentorial tumor. The tumors developing mainly supratentorial were approached from modified pteronal, subtemporal, temporooccipital or occipital craniotomy. For tumors developing mainly in the posterior cranial fossa, suboccipital craniectomy or combined occipital- suboccipital craniectomy was performed. The tumors developing both supratentorial and infratentorial the subtemporal-presigmoidal craniotomy were approached . Results: Total removal was achieved in 53 cases and partial removal in 3 cases. Two cases died of severe postoperative complications. The mortality rate was 3.6%. Five had additional neurological deficits postoperatively. Recurrences occurred in 6 cases. Conclusion: Surgical approach for tentorial meningiomas must be individualized for each case. The operators must master well about microanatomy of the tentorium and its specifically regional structures and expertly use microsurgical techniques for obtaining successful surgery and good outcome.