运动区附近大型脑膜瘤的显微手术治疗

Microsurgical removal of large meningiomas near motor area

目的探讨运动区附近大型脑膜瘤的大小与预后的关系及显微外科治疗方法。方法选择2005年1月-2010年1月在新疆喀什地区第一人民医院神经外科进行显微手术治疗的10例运动区附近大型脑膜瘤患者的临床资料进行回顾性分析,并对运动区附近大型脑膜瘤的大小与预后的关系、术中神经功能保护及术后神经功能康复进行总结。结果 10例运动区附近大型脑膜瘤患者按Simpson分级,Ⅰ级8例,Ⅱ级2例;全切率(包括按Simpson分级的Ⅰ、Ⅱ级)大脑凸面为100%,矢状窦旁为80%,大脑臁旁为90%。术后出现一侧肢体不同程度偏瘫或原有偏瘫体征加重3例,经脱水、高压氧等治疗,1个月内均有不同程度恢复,完全恢复2例。7例大型脑膜瘤远期生活质量评估(karnofsky performance scale,KPS)5分所占比例为85.7%(6/7),3例巨大型KPS 5分所占比例为66.7%(2/3)。结论对运动区附近大型脑膜瘤采用显微外科技术切除,结合脑膜瘤的大小分型,对临床治疗效果可能更有指导意义,术后对有神经功能损害者早期施行高压氧治疗,可有效提高和改善患者的预后。

Objective To investigate the relationship between the tumor size and the prognosis of large meningiomas near motor area and microsurgical techniques. Methods A retrospective study was on the clinical data of ten patients with harboring large meningiomas near motor area by microsurgical removal in the neurosurgical department of First People＇s Hospital of Kashgar during the period 2005--2010. We analyzed effects of tumor size on the prognosis of large meningiomas near motor area, intraoperative neurological protection, and postoperative neurological rehabilitation. Results A Simpson grade I or Ii resection was performed in 8 and 2 patients, respectively. Total removal rate was achieved in 100%0 in convexity, 80% in parasagittal sinus, 90%in falx. In the postoperative period, 3 patients presented new or deteriora ted hemiplegia. After dehydration and hyperbaric oxygen therapy, all case were improved in one month and 2 case were reversal. Among seven patients of large meningiomas, 85.7% （6/7） has a KPS of greater than 5, and among three patients of huge meningiomas, 66.6%（2/3） has a KPS of greater than 5. Conclusion Tumor size is critical prognosis factor of large meningiomas near motor area. Early hyperbaric oxygen therapy can improve neurological deficits in the postoperative period.