小脑幕褶皱脑膜瘤的分型与手术治疗

Tentorial fold meningioma: classification and treatment

目的 探讨小脑幕褶皱脑膜瘤的分型,并对预后结果进行回顾性分析研究.方法 回顾性分析近11年间在我院经手术证实的起源于天幕褶皱的连续21例脑膜瘤.肿瘤最大直径1～6 cm,平均值为2.76 cm.症状包括瞳孔大小不等、复视、上睑下垂、偏盲和共济失调等.随访周期1～36个月不等.根据肿瘤生长部位,分为三种不同亚型.结果 肿瘤切除程度达到SimpsonⅡ级19例,Ⅲ级1例,Ⅳ级1例.术后出现新的暂时性神经功能障碍2例,永久性神经功能障碍7例.2例神经功能障碍患者复查时得到恢复.结论 小脑幕褶皱脑膜瘤术后永久性动眼神经、外展神经障碍的发生率较高,术前应予以充分考虑.并且寻找相对的平衡点,最大限度的提高患者的术后生活质量.

Objective The classification of the tentorial fold meningiomas and outcome were discussed.Methods A retrospective analysis on 21 consecutive patients with meningiomas originating from the tentorial fold,who underwent surgery in the First Affiliated Hospital of Xijing Medical University between 2002 and 2012,was conducted.Tumor size ranged from 1 to 6 cm in diameter,with a median of 2.76 cm.The presenting symptoms of the patients were anisocoria,diplopia,ptosis,hemianopia,and ataxia.The follow-up period ranged from 1 to 36 months.The cases were classified according to tumor extension in three different types.Results As for the tumor resection,Simpson grade Ⅱ was achieved in 19 patients,Simpson grade Ⅲ in 1 patient,and Simpson grade Ⅳ in 1 patient.Post-operatively occurred transient neurological deficits were found in 2 cases and the permanent neurologcial deficits in 7 cases.The neurological deficits recovered in two patients in re-checking.Conclusion The incidence of permanent neurolgocial deficits in oculomotor nerve and outreach nerve is high,so much attention should be paid to before operation.A proper management of surgery should be chosen to improve the life quality of patients after operation to most extent.