不同入路下显微外科切除颅内巨大脑膜瘤28例临床分析

Microsurgical excisions of 28 large meningiomas with different apporachs

目的:探讨颅内巨大脑膜瘤的手术入路及治疗效果。方法:回顾性分析显微手术切除28例巨大脑膜瘤的临床资料。根据肿瘤所在部位,选择相应手术入路:双额冠状皮骨瓣纵裂入路9例,翼点入路1例,额颞入路3例,顶枕入路11例,枕下入路1例,远外侧入路1例,幕上下联合入路2例。结果:SimpsonⅠ级切除10例,Simp-sonⅡ级切除11例,SimpsonⅢ级切除5例,SimpsonⅣ级切除2例。19例获得随访,随访40 d^27个月,平均15.6个月,偏瘫2例均在1年内肌力逐渐恢复,生活自理;1例9个月内视力持续下降,左眼失明,右眼光感,2例5~11个月视力无改善;1例14个月后复发,1例死于其他疾病,余12例预后良好。结论:巨大型脑膜瘤血供丰富,大多数肿瘤已累及重要血管神经。手术入路应根据不同部位肿瘤生长的特点。

Objective： To study the effective methods and skills of microsurgical excisions of large meningio mas with different apporachs. Method： Twenty eight cases were analyzed retrospectively who experienced different apporachs to resect large meningiomas. According to the locations, different apporachs were experienced： via bilateral-fronto and longitudinal fissure apporach in 9 cases; via pterional apporach in 1 cases; via frontotemporal apporach in 3 cases; via parietooccipitales apporach in 11 cases; via suboecipital ap porach in 1 cases; via distallateral apporach in 1 cases; via supra and infra tentorium apporach in 2 cases. Results： The tumors were removed in Simpson Grade Ⅰ cases, removed in Simpson Grade Ⅲ in 5 cases, removed followed up for 40d-27 than 2 years. One patien mo tts in in 10 cases, removed in Simpson Grade Ⅱ in 11 Simpson Grade Ⅳ in 2 cases, 19 patients were nths ,averagely 15.6 months. The 2 hemiplgia patients had improved for less eyesight had depravated for 9 months, with one eye being blind and the other being light sensation. Two patients had no improvement in 9 months follow up period. One patient re curred after 14 months and 1 patient died from other illness. The rest 12 patients had good outcome. Conclusion. Large meningiomas have rich blood and great blood vessels and nerves have been affected tumors in different location. It should be removed in different apporachs.