鞍膈脑膜瘤的分类及其手术方法的选择

The types and the approaches of diaphragma sellae meningiomas

目的 探讨不同部位鞍膈脑膜瘤（DSM）的命名和分类，及其手术方法的选择与治疗结果的关系。方法 对CT扫描提示鞍结节脑膜瘤并向后发展者及垂体瘤病人，用MRI复查筛选共发现16例DSM，其中7例为A型（鞍膈上垂体柄前），4例为B型（鞍膈上垂体柄后），2例为C型（鞍膈下蝶鞍内），3例为混合型（累及鞍膈上下和垂体柄前后）。结果 16例病人均行手术治疗，其中14例全切除，2例大部切除，无手术死亡和严重功能障碍。结论 MRI是诊断DSM的最好方法，有助于鉴别垂体瘤和鞍结节脑膜瘤及其手术方法的选择。对于混合性DSM，分离垂体柄和血管更为困难，也难以完全切除。我们建议应把这类肿瘤列为D型或混合型。

Objective To study the types， approaches and treatment results of diaphragma sellae meningiomas DSM． Method 16 cases were diagnosed as DSM by MRI， 7 cases were type A， 4 were type B， 2 were type C， and 3 were type D． Result Totally removal of DSM were in 14 patients， and subtotal removal in 2． Neither postoperative mortality nor severe morbidity occur． Conclusion MRI is the best diagnostic method for DSM． Surgery for DSM is more difficult than tuberculum sellae meningiomas because of the deep location， particularly in the large tumors that included type A， B and C．