鞍区大型脑膜瘤的显微手术切除及三种手术入路的比较

Microsurgical resection of large meningiomas in the sellar region and the comparison between the three kinds of surgical approaches

目的探讨鞍区大型脑膜瘤手术入路的选择和肿瘤切除技巧。方法采用翼点入路、前额入路和眉上锁孔入路对23例脑膜瘤患者进行肿瘤切除。在术中仔细保护重要血管和结构、处理供瘤血管、分块切除肿瘤。结果非手术并发症死亡1例。肿瘤全切19例,未全切者中有3例行放射外科或常规放射治疗。术后视力视野改善10例。随访4月～6.5年,有3例肿瘤复发。结论根据肿瘤大小、生长特点选择相应手术入路,注意术中相关技巧,能提高肿瘤切除率和患者生命指数。

Objective To explore the selection of surgical approaches and techniques of tumor resection of large meningiomas in the sellar region. Methods Tumors of 23 cases were removed via the pterional, prefrontal and supraorbital keyhole approaches, without involving the vital blood vessels and structures. The tumor vessels were processed with care and tumors were removed by pieces during the surgery. Results One case died of non-surgical complication 5 days later after the surgery. Total resection was achieved in 19 cases and the other 3 cases with tumor partially removed were treated with stereotactic radiosurgery or routine radiotherapy. The eyesight and filed of vision in 10 cases were approved after the surgery, The follow-up study lasting 4 months to 6.5 years found that tumors of 3 cases recurred. Conclusion The relative surgical approaches chosen by the size and growth properties of tumors and attention to intraoperative techniques may enhance the resection rate of tumors and vital index of patients.