额颞开颅硬膜外治疗鞍结节脑膜瘤7例临床分析

Clinical study on 7 cases of tuberculum sellae meningiomas treated with extradural frontopterional craniotomy

目的探讨鞍结节脑膜瘤的显微手术治疗方法,提高手术效果。方法回顾性分析我科2003年1月至2006年6月7例手术治疗鞍结节脑膜瘤病例,其中男性2例,女性5例。年龄36～65岁,平均(43.6±2.4)岁。均有不同程度的视力障碍,7例均先行额颞开颅硬膜外视神经减压术治疗。结果按S impson手术切除的分级标准:Ⅰ～Ⅱ级5例(71.4%),Ⅲ～Ⅳ级2例(28.6%),无1例死亡。本组6例(85.7%)视力或视野有不同程度的恢复,视力无改变者1例(14.3%),无视力恶化者。结论与传统手术入路相比,采用额颞入路硬膜外视神经减压术治疗鞍结节脑膜瘤,可以最大限度的保护视神经及周围结构,有助于患者术后视力恢复及提高肿瘤全切除率,改善预后。

Objective To explore the microsurgical management of tuberculum sellae meningioma. Methods The data of 7 patients with tuberculum sellae meningiomas who were surgically treated between January 2003 to June 2006 were analyzed respectively （2 males, 5 females; ranged 36～65 years; mean 43.6±2.4 years）. All cases demonstrated different visual deficits and were treated by extradural optic nerve decompression via frontoptefional eraniotomy approach. Results Complete tumor removal （Simpson grade Ⅰ to Ⅱ） was achieved in 5 cases （71.4%） and subtotal removal （grade m to Ⅳ） in 2 eases （28.6%） with no morbidity. One patient （14.3%） with normal preoperative vision remained intact and visual improvement achieved in 6 cases （85.7%） at different degrees. There was no visual deterioration. Conclusion Compared with traditional approach, extradural optic nerve decompression by fronlopterional craniotomy in the treatment of tubereulum sellae meningiomas may protect the optic nerve and the surrounding structures to the most extent and be helpful for the vision recovery, the tumor removal and a better prognosis.