前颅窝脑膜瘤伴瘤周水肿的治疗

Treatment Experience of Meningiomas at Anterior Skull Base with Severe Peritumoral Edema

目的:回顾性分析前颅窝脑膜瘤伴瘤周水肿的临床特征,探讨术前、术中及术后的治疗经验。方法:分析我科前颅窝脑膜瘤伴有瘤周水肿9例临床资料,肿瘤位于:蝶骨嵴4例,前颅窝底及嗅沟5例。年龄37-68岁,平均52岁。结果:术后病理:WHO-Ⅰ级6例(66.7%),WHO-Ⅱ级2例(22.2%),WHO-Ⅲ级1例(11.1%)。9例术后脑水肿加重5例(55.6%),60岁以上老年患者发生率达3例(60%),2例因发生恶性脑水肿死亡。结论:术前充分告知和手术预案及手术路径的选择,术中对动、静脉血管尤其Heubner回返动脉的识别、保护是预防术后脑水肿加重的必需和有效措施。术后严密观察和细致护理,脱水药的应用,甚至及时的再次手术可提高此类患者手术的安全性,降低术后并发症的发生率和死亡率。

Objective：To analyze the clinical features and therapeutic experience of meningiomas at anterior skull base with severe peritumoral edema.Methods：The clinical data of 9patients with meningiomas at anterior skull base with severe peritumoral edema who underwent microsurgery were analyzed retrospectively,including 4cases at sphenoid ridge and 5cases at anterior skull base and olfactory sulcus.The mean age of the patients was 52（ranging 37-68）years.Results：Pathological results showed that 6cases of WHO-gradeⅠ（66.7%）,2cases of WHO-gradeⅡ（22.2%）,and1 case of WHO- grade Ⅲ（11.1%）.Deterioration of the brain edema was observed in 5cases（55.6%）after surgery,and in these five patients three were older than 60years（60%）.There were 2cases died of malignant brain edema postoperatively.Conclusion：Detailed preoperative preparation and correct choice of surgical approach are important.Carefully intraoperative vascular recognition,especially Heubner recurrent artery protection is most effective to prevent postoperatively malignant brain edema.Close observation and careful nursing after operation,the application of dehydration drugs,and even timely reoperation can help improve the prognosis of these patients