前纵裂入路显微手术切除巨大鞍结节脑膜瘤

Microsurgically resection of giant tuberculum sellae meningiomas through anterior interhemispheric approach

目的探讨经前纵裂入路显微手术切除巨大鞍结节脑膜瘤的方法、适应证及疗效。方法采用前纵裂入路切除直径>4cm鞍结节脑膜瘤30例,并对其临床资料及随访结果进行回顾性分析。结果手术切除结果按Simpson分级:Ⅰ级24例,Ⅱ级5例,共29例,占96.7%。术后视力改善20例,无改变6例,下降4例。尿崩或电解质紊乱8例,经保守治疗后好转,无死亡病例。结论前纵裂入路是切除巨大鞍结节脑膜瘤良好的手术入路,暴露充分,可提高全切除率和改善视力,并发症少。

Objective To investigate the method, indications and curative effect of microsurgical resection in patients with giant tuberculum sellae meningiomas through anterior interhemispheric approach. Methods The clinical data and follow-up results of 30 patients with tuberculum sellae meningiomas （maximum diameter 〉 4 cm ）, who underwent microsurgically resection through anterior interhemispheric approach were analyzed retrospectively. Results According to Simposon classification, of 30 patients 24 belonged in grade I , 5 in grade Ⅱ. Visual acuity were improved in 20 patients, remained in 6 and declined in 4. Diabetes insipidus or electrolytes derangement were found in 8 and no patient died postoperatively. Conclusion Anterior interhemispherie approach is an ideal surgical method for giant tuberculum sellae meningiomas with enough exposure, which can increase the rate of total removal of the tumors and imorove the visual acuity with minimum complications