内侧型蝶骨嵴脑膜瘤手术治疗

Classification and Treatment of Medial Sphenoid Ridge Meningiomas

目的探讨内侧型蝶骨嵴脑膜瘤分型及治疗方法，改善该类患者的治疗效果。方法对29例患者的影像学资料、治疗方法和结果进行回顾性分析。结果根据MRI所见肿瘤主体部位分为Ⅰ型（颅前窝型）9例，全切率100％；Ⅱ型（颅中窝型）16例手术治疗15例，全切10例，次全切4例，大部切除1例；Ⅲ型（混合型）4例，次全切3例，大部切除1例；术后视力改善12例，无变化2例，视力恶化1例，一过性偏瘫6例，一过性动眼神经麻痹2例，死亡1例；1例Ⅱ型患者拒绝手术行X-刀治疗，放疗后3个月因脑水肿脑疝行减压批半年复查MRI可见肿瘤体积缩小，肿瘤中心坏死；未能全切患者均行放疗，8例得以随访3个月-5年未见肿瘤增大。结论在患者安全的前提下尽量全切肿瘤应为首选的治疗方法，颅前窝为主的肿瘤全切率极高，颅中窝型和混合型全切率较低；对残余肿瘤应行放疗，在术后2个月左右脑水肿消退后行立体定向放疗可减少放疗引起的脑损伤。减少肿瘤复发机会。

Objective To explore the classification and treatment of medial sphenoid ridge meningiomas and improve curative effect of these patients. Methods 29 patients with medial sphenoid ridge meningiomas treated in our hospital were reviewed retrospectively. Results 29 patients were classified into three types according to region of tumors on MRI; Type Ⅰ （anterior possa） 9 cases： total removal was made in 100% patients; Type Ⅱ（middle possa） 16 cases： operation was made in 15 cases, total removal was made in 10 cases, subtotal removal in 3 cases and partial removal 1 case; Type Ⅲ（ mixed type） 4 cases： subtotal removal in 3 cases and partial removal in 1 case. There were 12 cases of patients with visual improment after operation, 2 patients unchanged and 1 case worsened post - operatively. Hemiplegia occurred in 6 cases, occlomotor nerve palsy in 2 cases and death in one case. X -knife treatment was made in 1 patient, cerebral herniation happened and decompression was made three months later ,tumor decreased and central putrescence happened half years in this patients. Radial therapy was carried out in all patients with residual tumors, 8 cases were followed - up and residual tumors did not changed from 3months to 5 years. Conclusion Medial sphenoid ridge meningiomas should be resected as totally as possible on the base of keeping patients safe. Total resection can be achieved in most Type Ⅰ, rate of total removal was low in Type Ⅱ and Type Ⅲ. Solid directioned radial therapy should be made in all patients with residual tumors.