小脑幕游离缘脑膜瘤的手术治疗

Neurosurgery for Meningiomas of Tentorial Incisures

目的总结手术治疗22例小脑幕游离缘脑膜瘤的经验。方法根据肿瘤附着的游离缘部位分为外侧组(14例)和后方组(8例)。回顾分析患者的临床表现、影像学资料、手术情况、病理检查结果、术后早期并发症等。结果22例小脑幕游离缘脑膜瘤患者的常见症状依次是头痛、步态障碍、头晕、听力损害和面部疼痛,主要体征依次是颅神经损害、共济失调、运动和感觉障碍。本组22例全切14例,大部切除8例。早期并发症发生率为31.8%(7/22),无病人死亡。外侧组手术采用颞下、枕下乙状窦后入路;后方组手术采用枕部经小脑幕或经镰幕双侧、双枕半球间入路。结论手术治疗小脑膜游离缘脑膜瘤应根据肿瘤部位、生长方向及与重要神经血管结构关系选择入路;静脉(窦)闭塞时,需重视侧支引流静脉建立方式和部位。

Objective To summarize the experience in surgically treating 22 patients with meningiomas of the tentorial incisures. Methods According to the location of the tentorial incisures attached to by the tumors, 22 patients with meningiomas of the tentorial incisures were divided into two groups, i.e. lateral group （14 cases） and posteromedial group （8 cases）. The clinical data of all the patients, including clinical manifestation, neuroimaging manifestation, surgical .records, and early complications after the operation, were analyzed retrospectively. Surgical approaches to the tentorial incisures included the subtemporal and suboccipital retrosigmoid approaches in the lateral group, and the occipital transtentorial approach or occipital transbitentorial/falcine approach and bioccipital interhemispheric approach in the posteromedial group. Results The common symptoms included headache, gait disturbance, dizziness, hearing loss, and facial pain, and the main neurological signs included cranial nerve deficits, ataxia and the disturbances of motor and sense in the patients with meningiomas of tentorial incisures. Of 22 patients with menigiomas of the tentorial incisures, 14 received total removal of the tumors （Okudesa-Kobaysash grade Ⅰ -Ⅲ） and 8 subtotal （Okudesa-Kobaysash grade Ⅳ and Ⅴ）. The rate of the early complication occurrence after the operation was 31.8% （7122）. No patients died. Conclusions The operative approach to the meningiomas of the tentorial incisures should be selected according to the site of the tumor, the direction of tumor extension, and the relationship between the tumors and neurovascular structures. The types and location of developed drainage collateral veins must be paid attention to when the veins or sinuses around the tumors has been occluded.