侧脑室脑膜瘤临床特点及显微外科治疗

The clinical characteristics and microsurgical treatment of lateral ventricular meningiomas

目的探讨侧脑室内脑膜瘤临床特点及显微外科手术方法和注意事项。方法回顾分析51例脑室内脑膜瘤患者的临床、影像学表现及手术方法。结果本组病例82.3%存在头痛与视乳头水肿,17.6%表现为阵发性头痛加重,27.4%出现内囊、丘脑、视放射、Werniche区受压局灶性神经功能障碍症状。采用颞间沟后部入路20例(39%),顶枕入路31例(61%)。肿瘤全切48例,新出现偏盲或视野缺损扩大6例,术后出现感觉性失语2例。3例肿瘤大部切除辅助伽马刀治疗。死亡3例(5.9%)。结论侧脑室内脑膜瘤症状以慢性颅内压增高为主,少数伴有阵发性头痛加重与局灶性神经功能缺陷。入路主要有经颞部与顶枕部两种,采用显微外科手术,注重微创原则,可得到较满意的治疗效果。

Objective To investigate the clinical characteristics, the operative techniques and microsurgical treatment of lateral ventricular meningiomas. Methods The clinical characteristics, surgical approach and imaging features of 51 patients with lateral ventricular meningiomas were analyzed retrospectively. Results A total of 42 patients （82.3% ） presented headache and papilledema and 9 patients （17.6%） aggravated headache. Fourteen patients （27.4%） were affected by neurodysfunction due to impairments at internal capsule, cerebral ganglion, optic radiation and Wernicke region. Twenty patients （39%） were operated via temple intergroove approach and 31 patients （61%） via parieto-occipital approach. Tumors were totally removed in 48 patients. The hemianopia and the enlarged deficit of visual field were detected postoperatively in 6 cases and acoustic aphasia in 2 cases. Three cases with subtotal tumor resection were treated with gamma knife. Three patients died （5.9%）. Conclusion The clinical characteristics of lateral ventricular meningiomas are mostly chronic intracranial hypertension with a few cases presenting aggravated paroxysm headache and focal neurodysfunction. Microsurgical remove is an effective treatment for the lateral ventricular meningiomas.