颅底脑膜瘤的手术治疗——157例报告

Surgery of Skull Base Meningioma:A Report of 157 Cases

背景与目的:颅底脑膜瘤手术难度大,本文总结157例颅底脑膜瘤的临床资料、影像表现和外科手术经验,探讨手术技巧与疗效。方法:我科自1990年1月至2005年5月手术治疗并经病理证实为颅底脑膜瘤者157例,最常见的症状为头痛,共92例(58.6%);其次为视力障碍,共53例,占33.8%。术前所有的患者均行CT和/或MRI检查,部分行脑血管造影检查。根据肿瘤的部位、大小和生长方式采用相应的手术入路,妥善处理肿瘤与血管、神经、静脉窦及脑干的关系,切除肿瘤。结果:87例达到肉眼全切,全切率为55.4%;次全切除57例,占36.3%;活检者13例,占8.3%。未全切的病例均进行放射外科治疗。最常见的并发症为术后神经功能障碍加重,本组病例中38例(24.2%),其中61%为一过性的,永久性的神经功能损伤占39%;术后脑脊液漏次之,为11例,占本组病例的7%;术后术区或远隔部位血肿病例8例(5.1%);新发癫痫和颅内感染各6例,占3.8%。本组病例中死亡6例(3.8%),其中因术后继发出血死亡3例,占死亡中的50%;其它原因死亡3例。结论:颅底脑膜瘤的最佳治疗方式仍为彻底手术切除,但存在一定的风险和死亡率,合理选择手术入路及显微神经外科技术对提高颅底脑膜瘤手术成功率具有重要的作用。

BACKGROUNC ＆ OBJECTIVE： To review the clinical data, image features, outcome and experience of surgical treatment of the 157 cases with skull base meningioma. METHODS： From January 1990 to May 2005, 157 patients with skull base meningioma were admitted to Southwest Hospital and received surgical treatment. Histology of meningioma were all validated by pathological examination. Headache （58.6%） was the leading symptom of referral followed by visual impairment （33.8%）. Magnetic resonance imaging （MRI）, Computed tomography （CT） scanning and in some patients, angiography were performed pre-operatively. All patients were treated surgically via the appropriate approach according to the size, location and extension of the tumors. Tumors were removed carefully with attention to adjacent vessels, nerves, venous sinus and brain stem. RESULTS： Total resections were achieved in 87 eases （55.4%）, Subtotal resection in 57 eases （36.3%）, and biopsy in 13 cases （8.3%）. The majority of complications was deterioration of neurological functions （24.2%）, but most of which （61%）were temporary, and only 39% of them had no improvement. The mortality rate was 3.8% with causes of postoperative hemorrhage, vasospasm or thromboembosis.. CONCLUSIONS ： Radical mierosurgleal resection of skull base meningioma remains the best treatment strategy. However, it is still a challenge to neurosurgeons with potential morbidity and mortality. The mierosurgleal skills play a very important role in the successful management of skull base meningioma.