显微手术治疗鞍结节脑膜瘤62例报告

Microsurgical Treatment of Tuberculum Sellae Meningiomas:A Report of 62 Cases

目的:探讨鞍结节脑膜瘤的临床特点、手术入路及显微手术技巧。方法:回顾性分析2002年1月至2009年12月收治经显微手术治疗的62例鞍结节脑膜瘤患者的临床资料。根据肿瘤大小、主体生长方向、与周围重要结构关系等选择不同的手术入路。其中,51例鞍结节脑膜瘤经翼点入路,6例经额下入路,5例经额下翼点联合入路切除肿瘤。结果:SimpsonⅠ级和SimpsonⅡ级切除肿瘤55/62例(88.7%),SimpsonⅢ级切除7/62例(11.3%),无手术死亡病例。对62例患者进行随访,随访期限4～96个月,平均随访期38.6个月。47/62例(75.8%)恢复正常生活,12/62例(19.4%)可生活自理,3/62例(4.8%)日常生活需他人帮助,随访期间3/62例(4.8%)肿瘤复发,再次行手术治疗。结论:显微手术治疗鞍结节脑膜瘤疗效确切,充分的术前准备和个体化的手术入路及良好的显微外科技巧,可显著提高肿瘤全切率和减少并发症。

Aim：To investigate the clinical characteristics,operative approaches and microsurgical technique of surgery for tuberculum sellae meningiomas.Methods：62 cases of tuberculum sellae meningiomas treated with microsurgery from January 2002 to December 2009 were analyzed retrospectively.The appropriate operative approaches may depend on the size and growth direction of the tumor and the relationship between the tumor and its adjacent tissues.51 cases were operated via the pterional approach,6 cases via the subfrontal approach,5 cases via combined subfrontal and pterional approach.Results：In the series of the patients,Simpson gradeⅠandⅡresection were achieved in 55 cases（88.7%）,and Simpson gradeⅢin 7 cases（11.3%）,there was no surgical mortality.The mean follow-up period was 38.6 months,ranging from 4 to 96 months.During the follow-up period,47 patients（75.8%） resumed work and normal life,12 patients（19.4%） obtained self care capability,and 3 patients（4.8%） needed to be taken care of.Recurrence of the tumor was found in 3 cases（4.8%）,and they were all reoperated.Conclusion：Microsurgical operation is a safe and effective way to treat the patients with tuberculum sellae meningiomas.It is obvious that the complete pre-operative preparation is very important.The choice of approach to tuberculum sellae meningiomas must be specifically individualized in each case.Skillful microsurgical techniques with appropriate surgical approach can improve the total resection rate and minimize the complications.