蝶骨嵴内侧型脑膜瘤的显微神经外科手术治疗

目的探讨蝶骨嵴内侧脑膜瘤的显微手术入路、切除技巧，提高肿瘤全切率及降低术后并发症。方法回顾性分析49例内侧型蝶骨嵴脑膜瘤病例的临床资料、显微手术过程疗效及预后情况。结果所有病例均接受显微外科手术，并按Simpson手术分级评定手术结果。肿瘤全切（Ⅰ、Ⅱ级）42例，其中Ⅰ级19例、Ⅱ级23例；Ⅲ级切除4例；Ⅳ级切除3例。无手术死亡，术后并发视力下降3例，不全瘫痪2例。结论采用精细的显微外科技术，术中对视神经、海绵窦及其内神经、颈内动脉及其分支的保护，提高内侧型蝶骨嵴脑膜瘤全切率，可显著提高疗效，减少肿瘤复发。

Objective To explore the microsurgical approaches and microsurgical techniques for improving the total resection rate of the tumors and prevention of postoperative complications. Methods The clinical data,microsurgieal course,curative effects and prognosis of 49 cases with medial sphenoid ridge meningioma who were admitted to our department were retrospectively reviewed and analyzed. Results All cases received microsurgery. The operative results were evaluated with Simpson grade system. Total removal was achieved in 42 cases （ grade Ⅰ,Ⅱ） with 19 cases in grade 1. 23 cases in grade Ⅱ ; grade Ⅲ removal was achieved in 4 cases and grade IV in 3 cases. No patient died of operation. Postoperative visual disturbance occurred in 3 cases and postoperative hemiplegia in 2 eases. Conclusion It is important to choose of suitable microsurgical techniques, manage and protect the vessels, nerves and the cavernous sinus region carefully , and heighten total resection rate of the tumors may improve the therapeutic efficacy and reduce the recurrent rate.