鞍结节脑膜瘤的显微外科治疗

Microsurgical treatment of tuberculum sellae meningiomas

目的探讨鞍结节脑膜瘤的显微外科治疗策略。方法对2005年1月至2013年7月应用显微外科手术治疗的鞍结节脑膜瘤35例进行回顾性分析，通过分析其手术入路、手术切除程度、手术效果及并发症等，总结鞍结节脑膜瘤显微外科治疗经验。结果所有患者均接受显微外科治疗，单侧额下入路20例，纵裂入路4例，翼点或扩大翼点入路10例，翼点及额下联合入路1例。肿瘤切除程度按Simpson分级评估，Ⅱ级26例，Ⅲ级4例，Ⅳ级5例，肿瘤全切除率达85．7％。术前合并不同程度视力视野障碍的28例，术后视力较术前好转20例，无明显变化5例，恶化3例。视力改善率71．4％。无死亡病例。结论鞍结节脑膜瘤周围毗邻结构重要，显微外科手术是其治疗的主要方法。应根据肿瘤大小、生长方式、视力受损程度及术者习惯等选择不同的手术入路。熟悉的显微解剖知识，娴熟的显微外科技巧是手术成功的关键。

Objective To explore mierosurgical treatment of tuberculum sellae meningiomas. Methods A retrospective analysis was made on 35 cases of tuberculum sellae meningiomas operated from January 2005 to July 2013 in neurosurgery department of Suu Yat-sen Memorial Hospital, surgical approach, removal rate, surgical effect and complications were analysed. Results All patients were accepted microsurgical treatment, twenty cases were operaled via subfrontal approach, four cases via anterior interhemispheric approach, ten cases via pterional approach, one case via combined subfrontal and pterional approach. According to Simpson grade, grade 11, rection was achieved in 26 cases, grade llI in 4 cases and grade 1V in 5 cases. The total rection rate was 85.7%. There were 2g cases with merger ision loss and visual field defects preoperate, twenty cases were improved after operation, five cases with no change, three cases aggravated. The visual improved rate was achieved 71.4%, there was no surgical mortality case. Conclusion The surround tissue of tuberculum sellae meningiomas is very import ant, microsurgical rection is the main treatment. The choice of surgical approach should according to tumor size, growth pattern, degree of impaired vision and surgeon experience. Family with microanatomy and skillfull microsurgical techique can make sure operation sncees.