嗅沟脑膜瘤的显微手术治疗

Microsurgical treatment for olfactory groove meningiomas

目的探讨嗅沟脑膜瘤的早期诊断及显微手术技巧。方法对30例采用额部冠状皮瓣及双额骨瓣开颅入路和翼点入路显微切除嗅沟脑膜瘤的临床资料进行回顾性分析。30例患者中瘤体最大直径≥6cm者共8例采用额部冠状皮瓣及双额骨瓣开颅入路,余22例均经翼点入路进行肿瘤显微切除术。结果30例中,按Simpson分级,I级切除23例,Ⅱ级切除6例,Ⅲ级切除1例。术后1例复查CT示额叶梗死,考虑大脑前动脉供血障碍,治疗1周后恢复;1例术后出现血糖增高和尿崩症,考虑视丘下部损伤,经对症处理,5d后恢复,无死亡。26例随访6月～4年,平均16个月。常规复查MRI,未见肿瘤复发。术前头痛、头昏及精神异常者术后基本消失,嗅觉及视力均有不同程度改善。结论早期发现,适宜的手术入路和精细的显微外科技巧可显著提高治愈率、降低致残率。

【Objective】To study the early diagnosis and microsurgical techniques of olfactory groove meningiomas.【Methods】 Clinical data of 30 patients with olfactory groove meningiomas who underwent microsurgical resection of olfactory groove meningiomas via the craniotomy of frontal coronary flap and bilateral frontal bone flaps and the pterional approach were analyzed retrospectively.Of the 30 cases,8 having the largest meningioma diameter≥6 cm underwent tumor microsurgical resection via the craniotomy of frontal coronary flap and bilateral frontal bone flaps approach,while the rest 22 via the pterional approach.【Results】Of the 30 cases,23 were resected with Simpson I grade,6 with Simpson Ⅱ grade,and 1 with Simpson Ⅲ grade.After operation,1 had frontal lobe infarction as shown by CT scanning recheck,and it was considered as blood supply insufficiency of anterior cerebral artery,yet the patient recovered after 1 week of treatment;1 had hyperglycemia and diabetes insipidus,and it was considered as the result of hypothalamus damage,but after receiving symptomatic treatment for 5 days,the patient survived.Follow-up from 6 months to 4 years,or 16 months on average,was given to 26 who,as shown by routine MRI recheck,did not have tumor recurrence.Patients who suffered from headache,dizziness and psychiatric disorder prior to operation no longer had such symptoms after operation and they got olfactory sensation and vision improved to different extent.【Conclusion】 Early diagnosis,appropriate approaches and expert microsurgical techniques could increase the cure rate and reduce the deformity rate.