天幕脑膜瘤的手术治疗

Surgical operation of tentorial meningiomas

目的：本文分析并探讨了64例小脑幕脑膜瘤的分型、手术入路和方法。方法：本文总结了1990年至2006年期间,64例小脑幕脑膜瘤（女39,男25）行手术治疗。患者年龄19～73岁（平均43岁）。临床表现为头痛（38例）、共济失调（33例）、头昏（28例）、听力下降/耳鸣（15例）、癫痫（8例）、颅神经损害（29例）。脑膜瘤分为三型：Ⅰ型（幕上型）：肿瘤主体位于幕上17例;Ⅱ型（幕下型）：肿瘤主体位于幕下32例;Ⅲ型哑铃型（幕上下型）15例：肿瘤向幕上下发展。其中,又根据肿瘤主体发展方向分为两个亚型：Ⅲa型4例：肿瘤主体位于幕上,向幕上发展;Ⅲb11例：肿瘤主体位于幕上,向幕下发展。结果：所有患者均行手术治疗,单纯幕下入路38例,单纯幕上入路19例,幕上幕下联合手术7例。手术切除的64例患者中,SimpsonⅠ级和Ⅱ级56例,Ⅳ级8例。无手术死亡的病例。结论：根据肿瘤的位置、大小及生长方向选择手术入路。术中尽量避免过度牵拉造成肿瘤周围组织及血管的损伤。此外,立体定向放射外科治疗可作为小脑幕脑膜瘤的补充治疗方案。

Objective To investigate and analyze the classification, approaches and operating methods of 64 tentorial meningiomas （TM）.Method Sixty-four tentorial meningiomas were operated from 1990 to 2006, 39 females and 25 males aged from 19 to 73 years （average of 43 ）. Clinical manifestations included headache in 38 cases, gait ataxia in 33 cases, dizziness in 28 cases, heating impairment/tinnitus in 15 cases, seizures in 8 cases, and cranial nerve deficits in 29 cases. The meningiomas were classified into 3 types： type Ⅰ supra-tentorial meningiomas, the meningiomas extending to supra-tentorium （ 17 cases） ; type Ⅱ： infra-tentorium meningiomas, the meningiomas extending to infra-tenterium （32 cases ）; type Ⅲ： dumbbell-shaped meningiomas, the meningiomas extending to supra-tentorium and infra-tenterium （15 cases）, which included two subtypes：Ⅲ a： the meningiomas located at the upper tentefium and extended to lower tentefium （4 cases ）; Ill b： the meningiomas located at the lower tenterium and extended above the tenterium （ 11 cases）. Results Sixty-four giant tentorial meningiomas were operated radically via supra-, infra- or combined tentorial approach and no mortality presented. Conclusion The operative approaches vary according to the location, size and extension of tumors. Impair to the tissues and vessels around tumors should be avoided in the operation. Moreover, the stereotaxic radiosurgery can be applied as supplementary treatment of tentorial meningioma.