前床突脑膜瘤的显微外科治疗

Microsurgical management of clinoidal meningiomas

目的探讨前床突脑膜瘤的分型和疗效。方法回顾性分析11例前床突脑膜瘤的临床表现、分型、手术及其效果。结果本组肿瘤全切除(SimpsonⅡ级)8例(72·7%),近全切除(SimpsonⅢ级)3例(27·3%),死亡4例(36·4%),预后良好5例(45·5%)。结论①前床突脑膜瘤可被分为鞍前型、鞍旁-鞍上型和广泛型,各型又可以根据是否侵袭或包裹海绵窦或颈内动脉分为A、B两个亚型。②前床突脑膜瘤的全切除应采取谨慎的积极态度,肿瘤侵袭海绵窦或颈内动脉是影响肿瘤切除程度和手术效果的关键因素,对于侵袭或直接附着于海绵窦或颈内动脉壁的瘤组织不应勉强切除,残余肿瘤可行立体定向放射外科治疗或密切随访。

Objective To explore the classification and the microsurgical resection of the clinoidal meningiomas. Methods Eleven cases of clinoidal meningioma that underwent microsurgical resection were analyzed retrospectively. Results Simpson grade Ⅱ resection were achieved in 8 cases （72. 7% ）. Simpson grade Ⅲ resection were achieved in 3 cases （27. 3% ）. 4 patients died （36. 4% ）. Satisfied outcome were achieved in 5 cases （45. 5% ）. Conclusion The clinoidal meningiomas could be divided into three types： presellar, parasellar-suprasellar, diffused type. Each type could be subdivided into A and B subtype according to whether the cavernous sinus or the internal carotid artery is invaded or encased by the tumor. The clinoidal meningiomas should be resected aggressively but prudently. Whether the tumor invades the cavernous sinus es- pecially the internal carotid artery is the key which determines the extent of resection and the outcome. The tumor which invades or attaches directly to the cavernous sinus or the internal carotid artery should not be resected constrainedly. The residual tumor could be treated with stereotactic radiosurgery or be followed up nearly.