镰幕交界处脑膜瘤

Falcotentorial junction meningiomas

目的探讨镰幕交界处脑膜瘤的诊断及手术入路选择。方法回顾性分析9例镰幕交界处脑膜瘤病人的临床资料。本组症状均以头痛、眩晕为主。手术选择枕经天幕入路8例,幕下小脑上入路1例。结果本组肿瘤均获SimpsonⅠ或Ⅱ级切除。无手术死亡。术后出现皮质盲3例,1～3个月后恢复。随访6～44个月,平均21个月;复发1例,行2次手术。结论镰幕交界处脑膜瘤的手术入路需根据肿瘤起源及扩展方向进行选择;术中需注意保护直窦和Galen静脉系统。

Objective To explore the diagnosis and surgical approach for meningiomas arising from the falcotentorial junction. Methods Clinical data of 9 patients diagnosed as having a falcotentorial junction meningioma were retrospectively reviewed. The main presenting symptoms of the patients were headache and dizziness. The tumor was resected via an occipital transtentorial approach in 8 cases, and via infratentorial supracerebellar approach in 1. Results A complete resection （Simpson Grade Ⅰ or Ⅱ） was achieved in all the cases. There was no operation mortality. Three patients presented homonymous hemianopsia after operation, which disappeared within one to three months. At a median follow-up of 21 months （range from 6 to 44 months）, tumor relapsed and was re-operated in 1 case. Conclusion The surgical approach for meningiomas arising from the falcotentorial junction should be selected according to tumor origin and extension and the straight sinus and Galenic venous system protected carefully.