中央区占位灶的手术策略(附13例报道)

Functional areas of space-occupying lesions surgical strategy

目的探讨中央区占位灶的手术方法和技巧。方法回顾性分析应用定向技术手术切除的中央区占位灶13例的临床资料,其中胶质瘤4例,镰旁脑膜瘤8例,脑脓肿1例。结果脑膜瘤切除按SIMPSON,S分级,I级切除6例,II级切除2例;胶质瘤大部切除3例,部分切除1例;脑脓肿脓液抽吸干净,囊壁大部分切除。术后肌力检查,3例较术前提高,6例无改变,4例下降;.随访3～6个月,肌力明显恢复,生活自理。术后感觉检查,术前4例感觉障碍,术后3例减轻,1例加重,随访3～6个月,症状明显改善。无死亡病例。结论精确的定位、正确的手术入路设计、术中重要血管的处理、功能区皮层功能的保护、脑肿胀的预防以及术后癫痫的防控是提高中央区占位灶切除术预后的关键。

Objective The paper explores the surgical methods and techniques of the space-occupying lesion in the functional areas.Methods 13 cases of space-occupying lesions with surgical resection in the functional area were analyzed retrospectively.These cases included glioma（4cases）,parafalx meningioma（8 cases） and brain abscess in the central region（1 case）.Results Meningioma＇ s resection is graded according to Simpsons,I-grade resection in 6 cases,II-grade resection in 2 cases;there are 3 cases of glioblastoma with subtotal resection,while partial resection in 1 case;brain abscess pus is sucked clean,most of the cyst removed.In postoperative muscle forces test,3 patients increased when compared with the preoperative,6 cases had no change,while 4 cases decreased compared with preoperative;In the follow-up 3 to 6 months,muscle strength was significant resume and achieve self-care.In postoperative sensory,s testing,of 4 cases with preoperative sensory dysfunction,3 patients after surgery are alleviated,and 1 case aggravate.In the follow-up 3 to 6 months,significant improvement,no dead case.Conclusion Precise positioning,the correct design of surgical approach,intraoperative treatment of major blood vessels,protection functional cortex function,the prevention of brain swelling,as well as prevention and control of postoperative epilepsy are the key to improvement of the resection prognosis of functional areas occupying lesion.