小脑幕脑膜瘤的显微外科治疗

MICROSURGICAL TREATMENT OF TENTORIAL MENINGIOMAS

目的：探索小脑膜脑膜瘤的手术入路和手术效果。方法：通过显微外科手术治疗２１例小脑漠脑膜瘤，根据肿瘤的生长方式和ＭＲＩ的表现分为四种类型，１型，小脑幕切迹外侧缘近岩骨尖，向中颅窝、海绵窦、上斜坡生长７例，２型，小脑幕切迹后内侧缘及镰幕交界处３例，３型，起源一离幕向ＣＰＡ生长６例，４型，小脑幕的其他部位，包括基底位于横窦、岩上窦及其骑跨型肿瘤５例。

Objective:To investigate the different surgical approaches and postoperative results of tentorial meningiomas.Methods:A retrospective analysis of 21 cases with tentorial meningiomas was performed.According to the primary site of attachment,tentorial meningiomas were divided into four types:Type Ⅰ,originating from the lateral tentorial incisura,extending to the middle cranial fossa,cavernous sinus and superior clivus (7 cases);Type Ⅱ,originating from the posteromedial tentorial incisura and the falcotentorial (3 cases);Type Ⅲ,tumors with mainly CPA development (6 cases);Type Ⅳ,originating from the rest of tentorial (5 cases).For three of type Ⅰ tumors developing mainly in the middle cranial fossa,subtemporal transtentorial approach was performed.The other of type Ⅰ tumors with mainly supraclival or midclival development were performed by temporal-occipital presigmoid approach.Poppen's approach was performed for type Ⅱ tumors.Type Ⅲ tumors were resected by using a lateral suboccipital retrosigmoid approach.For type Ⅳ tumors,surgical approaches included the infratentorial supracerebellar or the combined sub-and super-tentorial approaches.Results:According to the Simpson resection grades,four cases were grade Ⅰ resected;eight cases grade Ⅱ resected;nine cases grade Ⅲ resected.Conclusion:For type Ⅰ tumors,subtemporal transtentorial approach or suboccipital presigmoid approach was an optimal surgical approach of choice.By Poppen's approach,type Ⅱ tumors were easily exposed and obtained better removal.Total resection of type Ⅲ usually leaded to cranial never injury.In most cases type Ⅳ tumors could be totally resected.