前颅窝底脑膜瘤手术入路的选择与评价

Selection and Assessment of Operative Approaches for Removal of Meningiomas in Base of Anterior Cranial Fossa

目的 探讨和评价切除前颅窝底脑膜瘤的最佳手术入路。方法 回顾性分析我科手术治疗的前颅窝底脑膜瘤68例,将其分为前部和后部二组,大、中小三型,采用5种不同的手术入路,比较全切除率、手术结果和并发症发生情况。结果 肿瘤的全切除率与肿瘤大小和部位有关,中、小型肿瘤和前部肿瘤的全切除率较高。翼点入路和眶颧入路明显优于双侧或单侧额下入路,全切除率高,术后并发症少和手术效果好。结论 前颅窝底前部脑膜瘤宜采用眶颧侧裂入路,后部脑膜瘤宜采用翼点侧裂入路切除肿瘤,双侧额下入路应尽量少用。

Objective The best operative approach was inquired and assessed for removal of meningiomas in base of anterior cranial fossa. Methods A retrospective analysis was made in 68 cases of the frontal fossa meningiomas operatively treated by 5 different operative approaches from 1985 to 1997. The tumors were divided into anterior and posterior groups according to their sites and classified as large, middle and small types according to their size. The comparison was made in terms of total resection rate, operative results and complications among each group and type. Results There was a certain relationship between total resection rate and size or sites of the tumors and a higher rate of total resection in middle and small types and anterior tumors. The pterional approach and frontotemporal orbitozygomatic approach were superior to unilateral or bilateral subfrontal approach and had a list of advantages including satisfactory exposure, litde retraction of the frontal lobe, higher resection rate, less postoperative complications and better operative results. Conclusion The pterional approach and frontotemporal orbitozygomatic approach are more appropriate ones for removal of anterior and posterior cranial base miningiomas respectively. Bilateral frontal approach should be abandoned.