鞍结节脑膜瘤的诊治(附42例分析)

Diagnosis and treatment of tuberculum sellae meningiomas

目的 探讨如何运用显微神经外科技术治疗鞍结节脑膜瘤。 方法 42例鞍结节脑膜瘤中36例行显微神经外科手术，其中11例采用单侧额下入路，17例采用单侧翼点入路，6例采用眶上翼点联合入路，2例早期病例因术前误诊为垂体瘤采用经鼻蝶入路。 结果 按Simpson分级 Ⅰ级22例，Ⅱ级为10例，共占89％；术后视力改善的有14例27眼，无改变的为9例16眼，视力下降的有13例23眼，术前视力完全丧失的术后视力均未恢复。无死亡病例。 结论 术前正确诊断，选择合适的手术入路和应用显微神经外科技术是取得良好疗效的关键。

Objective To study the microsurgical techniques for treatment of tuberculum sellae meningiomas． Method 36 of 42 cases of tuberculum sellae meningiomas were operated using microneurosurgical skill unilateral subfrontal approach in 11 cases pterional approach in 17 and supraorbital－pterional approach in 6 2 patients misdiagnosed as pituitary adenomas were operated on by transsphenoidal approach． Result According to Simpson classfication 22 cases are grade Ⅰ 10 are grade Ⅱ together is 89％ improved visual acuity was achieved in 27 eyes of 14 cases remained in 16 eyes of 9 cases declined in 23 eyes of 13 cases． All blind patiends had no improved visual acuity． No death． Conclusion The keypoints for good results are right preoperative diagnosis suitable surgical approach and application of microneurosurgical skill．