天幕脑膜瘤62例分析

A review of 62 cases with tentorial meningiomas.

目的 探讨天幕脑膜瘤的分类与手术方法。方法 回顾性分析本院 1 990年 1月至 2 0 0 1年 1 0月间住院手术的 6 2例天幕脑膜瘤病例资料 ,重点讨论分类、手术入路的选择以及手术方法。结果 普通的天幕脑膜瘤 ,按肿瘤主体的位置及其延伸的方向分为前外侧、后外侧以及后内侧 3类 ,并结合肿瘤与天幕上下的关系 ,进一步分成幕上、幕下、幕上下 3型 ;天幕裂孔游离缘脑膜瘤依据解剖意义的不同分为侧方和后内侧 2组 ;肿瘤全切除 (SimpsonⅠ级和Ⅱ级 ) 5 2例 (83 9% ) ,肿瘤次全切除的 6例 (9 7% ) ,肿瘤大部分切除的 4例 (6 4% )。好转 4 6例 (74 2 % ) ,不变 9例(1 4 5 % ) ,加重 5例 (8 1 % ) ,手术死亡 2例 (3 2 % )。结论 天幕脑膜瘤适宜积极的手术治疗 ,规范分类。

Objective To study the classification and surgical technique of tentorial meningiomas. Methods A retrospective study was done on 62 cases hospitalized with tentorial meningiomas during the period between 1990 and 2001. The classification of tumor, the selection of surgical approach and the surgical technique were reviewed.Results The ordinary tentorial meningiomas was classified as anteriolateral, posteriolateral or posteriomedial group according to site of attachment and extension of the tumor. Combined with the relationship to the tentorium, it was further divided into three subgroups: supratentorial, infratentorial, and supra-infratentorial. Anatomically, meningiomas of tentorial notch was classified as the lateral tentorial incisura and posteriomedial tentorial incisura meningioma. Total tumor removal (Simpson Ⅰ and Ⅱ) was achieved in 52 cases(83.9%), subtotal in 6 cases (9.7%), and partial in 4 cases (6.4%). The outcome was good in 46 cases (74.2%), fair in 9 cases (14.5%) and poor in 5 cases(8.1%). The mortality rate was 3.2%. Conclusions Tentorial meningiomas is amenable to aggressive surgery. Standardized classification, appropriate surgical approach and technique may improve the therapeutic effect of tentorial meningioma.