小脑幕脑膜瘤的显微外科治疗

Microsurgery treatment of tentorial meningioma

目的总结小脑幕脑膜瘤的显微外科手术治疗经验。方法回顾分析2003年3月至2008年9月18例经显微外科手术治疗的小脑幕脑膜瘤病人的临床表现、影像学检查、手术记录、病理及术后早期并发症。结果全切除13例（Simpsom I级4例，Ⅱ级9例），占72．2％；近全切除（Simpsom Ⅲ级）5例，占27．8％；无手术死亡病例。术后并发症4例，主要为脑神经损伤、小脑损伤、脑脊液漏、偏盲、颅内／切口感染。术后随访1～6年，平均4．1年，仅1例手术后2年复发。结论肿瘤基底及肿瘤与神经血管的关系是选择小脑幕脑膜瘤手术入路的重要依据；术中对静脉窦和回流静脉的保护至关重要。如全切肿瘤可能带来重要的神经功能损害，则应考虑残留部分肿瘤。

Objective To summarize experience of microsurgery treatment for tentorial meningioma. Methods The clinical manifestation, neuroimaging datas, operation record, pathological findings and early postoperative complications of tentorial meningioma in 18 patients who underwent microsurgery operation from March 2003 to September 2008 were retrospectively analyzed. Results The tumors of 13 patients （Simpson grade Ⅰ ：4 cases,grade Ⅱ ：9 cases;72. 2% ） were totally removed, and tumors of 5 patients （ Simpson grade III ,27.8% ） were subtotally resected. There were no operative deaths. Postoperative complications were seen in 4 patients including injury of cranial nerves, cerebellar injury,leakage of cerebrospinal fluid, hemia- nopsia,intracranial infection and/or infection of incisional wound. During 1 to 6 years （mean 4. 1 years） followed up period, only one patient recurred 2 years after operation. Conclusions The management of tumor＇s bases and the relationship between tumor and neurovascular structures are the important criteria for choosing surgical approach. Protection of venous sinus and circumfluent vein is a principle of the utmost importance. If complete resection of tumor will likely lead to damage of important nervous function, subtotal remove should be considered.