幕上巨大脑膜瘤的显微手术治疗(附42例分析)

Microsurgery for superatentorial giant meningiomas: analysis of 42 cases

目的总结幕上巨大脑膜瘤的手术切除经验。方法回顾性分析42例幕上巨大脑膜瘤的临床特点、手术入路及切除方法。结果本组Simpson0-Ⅰ级切除31例（73．8％），Ⅱ-Ⅲ级切除8例（19．1％），Ⅳ级切除3例（7．1％）。无手术死亡病例。随访34例，平均28个月；复发2例。结论充分进行术前准备，术中合理应用瘤内切除技术并在显微镜下剥离瘤壁，是提高手术疗效的关键。当肿瘤与静脉窦、重要神经结构黏连紧密时，应采取次全切除或部分切除，残留肿瘤可行放射治疗。

Objective To summarize the surgical experiences for superatentorial giant meningiomas. Methods Clinical features, surgical approaches and surgical resection type of giant meningiomas on the tentorium at different sites in 42 examples were retrospectively analyzed. Results Simpson Grade 0 to Ⅰ resection was achieved in 31 cases （73.8%）, Grade Ⅱ to Ⅲ in 8 （19.1%）, and Grade Ⅳ in 3 （7.1%）. There was no dead patient in the group. Thirty-four patients were followed up for average of 28 months, with recurrence in 2 cases. Conclusion The key points of increasing total resection rate are careful preoperative preparation, proper skill for intratumoral excision, and stripping the tumor wall under a microscope. Subtotal or partial resection should be adopted when the tumor was adhered to the blood vessel, venous sinus or other important neural structures, and the residual tumor could be treated by radiation treatment.