额外侧入路与翼点入路显微手术治疗鞍结节脑膜瘤

Microsurgical treatment of tuberculum sellae meningioma via frontolateral approach and transpterygoid approach

目的探讨鞍结节脑膜瘤的临床特点、手术入路及视力保护策略。方法回顾性分析武警总医院神经血管外科从2009年6月—2013年5月连续收治的17例鞍结节脑膜瘤病人的临床资料,分别采用额外侧入路及翼点入路行手术治疗,比较肿瘤全切除率、视力改善率和并发症的发生情况。结果经额外侧入路8例患者,获SimpsonⅠ级切除3例,Ⅱ级切除5例。经翼点入路9例患者,获SimpsonⅠ级切除4例,Ⅱ级切除3例,Ⅲ级2例。术后视力损害和视野缺损均有不同程度恢复13例,2例视力无改变,术后视力下降2例。4例术后出现不同程度的尿崩,2例出现下丘脑受损症状,经对症治疗后好转出院。手术无死亡病例,效果满意,术后随访1个月～4年均恢复良好。结论根据肿瘤不同生长方式选择恰当手术入路,应用娴熟的显微外科技术可以提高手术全切率,术中注意对鞍区重要结构的保护对改善患者预后有重要关系。

Objective To investigate the clinical features and surgical approaches of tuberculum sellae meningiomas （ TSM）, and visual acuity protective methods were also discussed with special attention. Methods From June 2009 to May 2013, 17 patients with TSM admitted at the department of neurovascular of our hospital. The clinical data were analyzed retrospectively, all the 17 patients were operated via the frontolateral approach and the ptefional approach separately. Total resection rate, postoperative visual acuity improvement and the incidence of complications were compared between the two surgical approaches. Results 8 cases were operated via the frontolateral approach, Simpson grade I resection was achieved in 3 cases, and Simpson grade Ⅱ in 5 cases. 9 cases were operated via the pterional approach, Simpson grade Ⅰ resection was achieved in 4 cases, Simpson grade H in 3 cases and Simpson grade Ⅲ in 2 cases. Of all the 17 patients, 13 were improved in visual acuity, 2 remained unchanged and 2 deteriorated. Transient postoperative diabetes insipidus occurred in 4 cases and hypothalamus dysfunction in 2 patients, they all gradually recovered after symptomatic treatments without fatal consequences. There is no death caused by surgery. The surgical results were satisfactory. The time of follow - up was 1 month to 4 years, all cases were well recovery. Conclusion The proper operative approach and skillful microsurgical techniques can improve the total resection rate. Protecting the major structures near the TSM is very helpful to the improvement of the prognosis in the patients with TSM.