显微手术不同术式治疗嗅沟脑膜瘤

Treatment of olfactory groove meningiomas through various operative approaches for microsurgery

目的探讨嗅沟脑膜瘤的手术入路选择。方法应用显微外科手术治疗嗅沟脑膜瘤39例,分别采用经双(单)侧额下入路21例,经翼点(改良)入路10例,经眶额入路6例,经前纵裂半球间入路2例共四种术式切除。结果据脑膜瘤Simpson分级切除标准,SimpsonⅠ级切除28例,SimpsonⅡ级切除10例,SimpsonⅣ级切除1例,无手术死亡。结论全切除(SimpsonⅠ～Ⅱ级)肿瘤是嗅沟脑膜瘤根治的有效途径。恰当合适的手术入路是肿瘤根除重要保证。术式的选择应结合肿瘤的实际,以肿瘤全切除,减少复发并利于颅底修补重建为目的。

Objective To explore several operative approaches for microsurgical treatment of olfactory groove meningiomas.Methods The olfactory groove meningiomas in 39 cases were removed microsurgically through various approaches,among which 21 cases were performed through the bilateral subfrontal approach or unilateral subfrontal approach,10 cases were performed through modified derome approach,6 cases were performed through orbital frontal approach,2 cases were performed through interhemisperic approach.Results Simpson gradeⅠ removal was accomplished in 28 cases,gradeⅡ in 10 cases and grade IV in one case.These was no death in surgery.Conclusion Total tumor removal（SimpsonⅠ~Ⅱ）should be the surgical goal for treatment of olfactory groove meningiorrms,An appropriate approach is fundamental in the effort to remove an OGM totally.The choice of the operative approach is tightly relative to the tumorous reality.The purpose should be to reduce the recurrence,achieve subtotal resection and reconstruction for the repair.