经颅入路切除蝶-眶脑膜瘤32例临床分析

Transcranial approach for resecting spheno-orbital meningiomas

目的探讨经颅入路切除蝶-眶脑膜瘤的手术方法及疗效。设计回顾性病例系列。研究对象32例蝶-眶脑膜瘤患者,其中良性脑膜瘤(WHOⅠ级)28例,其中上皮型24例,纤维型3例,砂粒体型1例;生长活跃或不典型脑膜瘤(WHOⅡ级)2例;恶性脑膜瘤(WHOⅢ级)2例。方法采用发际内额颞弧形切口,在硬脑膜外磨除增生的蝶骨大翼骨质,眶上裂、视神经管开放减压,增厚的眶骨膜连同肿瘤一并切除,用颞肌筋膜或人工脑膜修补硬脑膜及眶骨膜缺损。主要指标术前、术后突眼,眼球运动等临床表现,肿瘤的切除程度及复发率。结果肿瘤切除程度:SimpsonⅡ级8例、SimpsonⅢ级20例、SimpsonⅣ级4例。术后突眼情况均有好转,6例患者术后外展受限,4例上睑下垂。随访有6例患者肿瘤复发。结论经颅入路切除蝶-眶脑膜瘤可获得充分的肿瘤显露和眶尖减压,手术入路安全,可有效缓解突眼症状。因肿瘤多累及眶尖、眶上裂、海绵窦等重要组织结构,肿瘤难以完全切除,术后复发率较高。

Objective To explore the effect and safety of transcranial approach for spheno-orbital meningioma. Design Retrospective case series. Participants Thirty-two patients being operated with transcranial approach. Twenty-four cases were meningothelial meningiomas, 3 cases were fibrous meningiomas, 1 case was psammomatous meningioma, 2 cases were atypital meningiomas, 2 case were malignant meningiomas. Methods All patients underwent frontal-temporal craniotomy, the involved sphenoid wing bone and periorbit were removed to prevent recurrence. The superior orbital fissure and optic canal were decompressed, the dural and periorbital defect were repaired by autogenous temporal fascia or artificial dura. Main Outcome Measures Preoperative and postoperative exophthalmus and eyeball movement, the extent of tumor resection, the ratio of recurrence. Results The extent of tumor resection： 8 cases were Simpson grade Ⅱ, 20 cases Simpson grade Ⅲ, 4 cases Simpson grade Ⅳ. After surgery, proptosis were improved in all patients, ophthalmoplegia was found in 6 cases. There was no operation-related death or other significant complication. Tumor recurred in 6 cases. Conclusions Adequate exposure of the tumor and bony decompression of the cranial nerves can result from transcranial approach, all the involved bone should be removed in order to prevent recurrence. This approach is relatively safe and the ptoptosis are improved significantly. Complete surgical resection is difficult because of the involvement of the orbital apex, superior orbital fissure and cavernous sinus.