蝶骨嵴内侧脑膜瘤显微手术治疗及切除程度影响因素分析

Microsurgical treatment for medial sphenoid wing meningioma and factors affecting tumor removal

目的探讨蝶骨嵴内侧脑膜瘤显微手术治疗效果及影响切除程度的临床病理因素。方法回顾性分析中南大学湘雅医院神经外科1985年11月-2009年10月手术治疗的127例蝶骨嵴内侧脑膜瘤患者临床资料并对其进行随访研究。采用单因素分析肿瘤大小、侵犯海绵窦、粘连颈内动脉、质地对切除程度的影响。结果全组患者无手术死亡。肿瘤全切除104例,全切除率为81.9%。随访患者120例,7例患者失访。平均随访81.6个月,随访平均生活质量评分（KPS评分）90.6分,肿瘤全切除98例病例复发10例,复发率10.2%;22例次全切除患者肿瘤进展10例,进展率45.5%。单因素分析结果显示：肿瘤侵犯海绵窦、直接粘连颈内动脉及分支以及肿瘤大小是影响全切除的因素,而与肿瘤质地无关。结论蝶骨嵴内侧脑膜瘤显微手术治疗能获得良好的远期疗效,其第一次手术治疗彻底切除肿瘤对于患者预后至关重要。肿瘤侵犯海绵窦、粘连颈内动脉及分支以及肿瘤大小是影响肿瘤全切除的主要因素。

Objective To analyze the therapeutic effect of medial sphenoid wing meningioma with microsurgical treatment and factors affecting the extent of resection. Methods Clinical data of 127 patients suffering from medial sphenoid wing meningioma resected microsurgically in our department between Nov 1985 and Oct 2009 were analyzed retrospectively. The factors that might affect the extent of tumor resection including tumor size,cavernous sinus invasion,internal carotid artery and its branches adherence and texture of tumor were analyzed statistically. Results There was no operative mortality. Total removal of meningioma was achieved in 104 patients with a total removal rate of 81. 9%. Followup was got in 120 cases with an average period of 81. 6 months. 7 patients were lost to follow-up. The mean quality of life score（ KPS score） was 90. 6 points. 10 patients experienced recurrence among 98 total removal cases with a recurrence rate of 10. 2%. 10 patients experienced progression among 22 subtotal removal cases and the rate was 45. 4%. Univariate analysis showed that the cavernous sinus invasion,adhesion to carotid artery and its branches as well as tumor size negatively affected tumor removal,regardless of the tumor texture. Conclusions The long-term outcomes of medial sphenoid wing meningioma can be satisfied by microsurgical treatment and the first surgery to completely remove the tumor is crucial for prognosis. Tumor invasion of the cavernous sinus,internal carotid artery and its branches adhesion and tumor size are major factors affecting tumor removal.