大型蝶骨嵴内侧脑膜瘤的显微外科治疗策略

Microsurgical strategies of medial sphenoid ridge meningiomas

目的探讨大型蝶骨嵴内侧脑膜瘤的显微手术入路,切除技巧及术后并发症预防等相关问题的处理方法。方法回顾性分析2000至2006年间我科收治的37例内侧型蝶骨嵴脑膜瘤病例的临床资料、显微手术过程及疗效预后情况。结果所有病例均接受显微外科手术,并按Simpson手术分级评定手术结果。肿瘤全切(Ⅰ、Ⅱ)32例,其中Ⅰ级14例,Ⅱ级18例;Ⅲ级切除3例;Ⅳ级切除2例。无手术死亡,术后并发视力下降3例,2例不全瘫痪。术后1年MRI扫描,Ⅰ、Ⅱ级切除组病例未见肿瘤复发,III级切除有2例复发,次全切除组(Ⅳ级)全部复发。结论采用精细的显微外科技术,仔细辨别肿瘤与周围血管、神经间的蛛网膜间隔,在充分保全与肿瘤粘连血管、神经的前提下最大限度地切除肿瘤,可显著提高疗效,减少肿瘤复发。对未能全切病例,术后放疗可延缓肿瘤复发。

Objective To analyze and explore the microsurgical approaches, microsurgical techniques and prevention of postoperative complications. Methods The clinical data, microsurgical course, curative effects and prognosis of 37 cases with medial sphenoid ridge meningioma admitted to our department from 2000 to 2006, were retrospectively reviewed and analyzed. Results All cases accepted microsurgery. The operative results were evaluated with Simpson grade system. Total removal was achieved in 32 cases （grade Ⅰ, Ⅱ） with 14 cases in grade Ⅰ, 18 eases in grade Ⅱ; grade Ⅲ removal was achieved in 3 cases and grade Ⅳ in 2 cases. No patient died of operation. Postoperative visual disturbance occurred in 3 cases and postoperative hemiplegia in 2 cases. One year after operation, MRI scan showed no recurrence in groups of grade Ⅰ and grade Ⅱ resection, 2 cases of recurrence in group of grade Ⅲ resection and all patients presented recurrence in group of grade Ⅳ resection. Conclusion Choice of suitable microsurgical techniques, careful identification of the arachnoid intervals between tumor and important adjacent structures and total resection with protection of the important adjacent structures may improve the therapeutic efficacy and reduce the recurrent rate. Postoperative radiotherapy can postpone the recurrence in incompletely resected cases.