182例颅内大型脑膜瘤的显微手术治疗

Microsurgical Treatment for Large Intracranial Meningiomas:a Retrospective Study in 182 Cases

目的研究显微手术治疗颅内大型脑膜瘤的疗效;总结颅内大型脑膜瘤显微手术的要点和术后并发症的防治经验,进一步提高颅内大型脑膜瘤的手术全切率,降低手术死亡率。方法对从2001年1月至2005年6月本组显微手术治疗的182例颅内大型脑膜瘤(最大径>4.5cm)患者的临床资料进行回顾性分析,并结合文献,对大型脑膜瘤显微手术要点和术后并发症的防治进行讨论。结果本组颅内大型脑膜瘤显微手术总的全切率达到89.0%(包括按Simpson分级的Ⅰ、Ⅱ级)。颅底大型脑膜瘤中,桥小脑角脑膜瘤、蝶骨嵴脑膜瘤、嗅沟脑膜瘤、鞍结节鞍膈脑膜瘤的手术全切率分别达到了84.6%(11/13)、82.1%(23/28)、80.0%(16/20)、69.2%(17/23)。本组无死亡病例(术后4周内统计)。结论显微手术切除是目前根治颅内大型脑膜瘤首选治疗方法。良好的显微手术技术和对颅内各部位特别是颅底解剖的熟悉是提高手术全切率和减少术后并发症的前提。对手术后并发症的正确诊断和及时治疗能有效降低手术的死亡率和致残率。

Objectives To study the curative effect of the microsurgery on the large intracranial meningiomas and to summarize the operative gists and the experiences in preventing and treating the postoperative complications in order to enhance the rate of total resection of the tumor and to lower the mortality rate. Methods The clinical data of 182 patients with large intracranial meningiomas （diameter〉4.5 cm）, who underwent microsurgery from January 2001 to June 2005 in our hospital, were analysed retrospectively. The operative gists and the measures of preventing and treating the postoperative complications were discussed according to our experiences and related literature. Results The rate of total resection of the tumors was 89.0% including Simpson＇s Grade Ⅰ and Grade Ⅱ in all the patients with intracranial large menigiomas. The rates of total section of the large intracranial meningiomas in cervebelloporitine angle, the crista sphenoidalis, the olfactory sulcus and the sella area were 84.6%（11/13）, 82.1%（23/28）, 80.0%（16/20） and 69.2%（9/13）. No patients died within 4 weeks after operation. Conclusion The microsurgical resection is the primary therapy for the large intracra- nial meningiomas. The skillful microsurgical technique and familiar intracranial anatomy, especial sellar anatomy, are necessary to derease the postoperative complications and to enhance the rate of total section of the tumors in the patients with large intracranial menigiomas. The exact diagnosis and prompt treatment of the postoperative complications can significantly reduce the operative mortality rate and the disabled rate.