鞍结节脑膜瘤的显微外科治疗体会

Experience of microsurgical management of tuberculum sellae meningiomas

目的探讨鞍结节脑膜瘤的显微外科手术入路及技巧。方法回顾性分析2000-01—2011-12我院脑外科行显微手术治疗53例鞍结节脑膜瘤患者的临床资料和影像学特点,根据肿瘤大小、主体生长方向、与周围重要结构关系等选择不同的手术入路。结果本组53例患者41例采取经翼点入路,7例经额下入路,5例经额下翼点联合入路。肿瘤SimpsonⅠ级切除30例(56.6%),SimpsonⅡ级切除17例(32.1%),SimpsonⅢ级切除6例(11.3%)。视力改善率64.2%(34/53)。术后恢复良好41例,优良率为77.4%,中度残疾6例(11.3%),重度残疾3例(5.7%),死亡3例(5.7%)。结论详细的术前准备和个体化的手术入路以及良好的显微外科技巧,充分囊内切除肿瘤,术中注意视神经及重要血管的保护,可提高肿瘤全切率,减少并发症,降低病死率。

Objective To explore the approach and skill of microsurgery for tuberculum sellae meningiomas. Methods The clinical data and imaging features of 53 cases of tuberculum sellae meningiomas patients from Jan 2000 to Dec 2011 in de- partment of neurosurgery in our hospital were retrospectively analyzed. Different surgical approaches according to tumor size, growth, and surrounding important structures were selected. Results Of 53 patients, the tumors were removed through pteri- onal approach in 41 cases, 7 cases through subfrontal approach, and 5 cases through subfrontal pterional approach. Simpson grade I resection was achieved in 30 cases, grade Ⅱ resection in 17 cases, and grade Ⅲ resection in 6 cases. The percentage of visual acuity improvemwnt was 64.2%. Postoperatively, 41 cases recovered well, 6 cases had a mild disability, 3 cases suf- fered a severe disability and 3 cases died. Conclusion Complete pre-operative preparation, individualized surgical approach ,appropriate microsurgical skills, the full removal of the tumor capsule, intraoperative attention to the protection of the optic nerve and major blood vessels can markedly boost the total resection rate of tuberculum sallae meningiomas and lower the postoperative complications and mortality.