侧脑室三角区脑膜瘤的手术治疗

Operation of lateral ventricular meningiomas of the trigone

目的总结侧脑室三角区脑膜瘤的手术治疗经验。方法对64例三角区脑膜瘤患者的临床疗效进行了回顾性分析。64例中肿瘤位于左侧40例,右侧24例。病理学类型:纤维型35例,混合型10例,内皮型8例,移行型3例,分泌型1例,恶性1例,未分型的6例。结果肿瘤直径平均4.8cm。对所有病例均在显微镜下进行了肿瘤全切除,无一例发生手术死亡。术后并发症有偏瘫4例,失语14例,偏盲2例,发热超过1周甚至2周以上共30例,局限性脑积水4例。术后失语的发生率与开颅部位有关(皮尔逊相关系数=0.404,P=0.001),与肿瘤的侧别有关(皮尔逊相关系数=0.313,P=0.012),与肿瘤直径有关(皮尔逊相关系数=0.284,P=0.023)。术后发热与肿瘤直径相关(皮尔逊相关系数=0.367,P=0.003),与肿瘤的切除方式相关(皮尔逊相关系数=0.537,P=0.000)。在肿瘤直径≥4cm 的病例中,术后住院天数与脑室是否放引流无明显相关(皮尔逊相关系数=0.047,P=0.748)。结论顶枕和颞顶枕开颅是切除位于三角区的脑膜瘤较好的手术入路。术中尽量减少对周围脑组织的损伤并尽量减少对脑室系统的污染是避免术后并发症的关键。

Objective To summarize the surgical treatment of intraventricular trigonal meningiomas. Method 64 cases of intraventricular trigonal meningiomas were retrospectively analyzed. 40 tumors were located in the left trigone and 24 tumors in the right. Pathological diagnosis included 35 fibrous, 10 mixed, 8 endothelial, 3 transitional, 1 secretion and 1 malignant meningioma. The remaining 6 cases cannot be classified into any type. Result The tumors ranged in diameter from 2 cm to 15 cm （ median 4. 8 cm）. Microscopic complete removal was achieved in all cases. Postoperatively, hemiparalysis occurred in 4 cases, aphasia in 14, hemiopia in 2, persistent fever （last more than 7 days ） in 30 and focal hydrocephalus in 4. There was no mortality. The incidence of postoperative aphasia was correlated with operational approach （ Pearson correlation coefficient = 0. 404, P = 0. 001 ） , tumor side （ Pearson correlation coefficient = 0. 012, P = 0. 012 ） and size （ Pearson correlation coefficient = 0. 284, P = 0. 023 ） . Postoperative persistent fever was correlated with size （ Pearson correlation coefficient = 0. 367, P = 0. 003 ） and resection method （Pearson correlation coefficient = 0. 537, P = 0. 000）. In cases of diameter≥4 cm, length of stay was not correlated with ventricular drainage （ Pearson correlation coefficient = 0. 047, P = 0. 748）. Conclusion Transcortical parieto-occipital approach and Transcortical temporo-parieto-occipital approaches are applicable for intraventricular trigonal meningiomas. The key points to avoid postoperative complications are to decrease damage to surrounding brain tissue and pollution to ventricles.