显微技术在窦汇区脑膜瘤手术治疗中的应用

Microsurgical treatment of meningiomas in torcular herophili region

目的:探讨窦汇区脑膜瘤的显微手术治疗策略。方法:回顾性分析2011年11月~2015年4月我院显微切除14例窦汇区脑膜患者的临床资料、手术入路、肿瘤切除程度、术后辅助治疗及随访情况。结果:按simpson切除分级标准,Ⅰ级切除5例,Ⅱ级切除4例,Ⅲ级切除4例,Ⅳ级切除1例。术后病理分级,WHOⅠ级13例,WHOⅡ级1例。术后出现硬膜下积液1例,走路不稳、闭目难立1例,剧烈呕吐1例,一侧肢体肌力下降1例。术后随访5~45个月,平均(23.6±12.82)个月,无死亡病例,无肿瘤复发。结论:详细的术前评估、适当的手术入路、术中对静脉窦的处理以及肿瘤切除程度的评估,必要的术后辅助放射治疗,可以降低窦汇区脑膜瘤治疗的风险和复发率。

Objective： To investigate the strategies by microsurgical treatment of meningiomas in torcular herophili region.Methods： The data,including clinical information,surgical approach,extent of the tumor removed,postoperative adjunctive treatment,were retrospectively analyzed in 14 cases of meningiomas at torcular herophili region treated by microsurgery in our hospital between November 2011 and April 2015.Results： By Simpson grading,the extent of tumor resection was in grade Ⅰ in 5 cases,gradeⅡ in 4,grade Ⅲ in 4,and grade Ⅳ in 1.Postoperative histopathology by WHO classification revealed that 13 cases were in grade Ⅰ and 1 case in grade Ⅱ.The complications included subdural effusion in 1 case,ataxia and Romberg＇s sign in 1,severe vomiting in 1,and unilateral muscle weakness in another 1.The follow-up ranged from 5 to 45 months,with a mean（ 23.6± 12.82） months. No death or relapse occurred.Conclusion： Careful preoperative planning,appropriate surgical approach,intraoperative venous sinus protection and evaluation of the extent of tumor removed plus needed postoperative adjunctive radiotherapy may reduce the risks of surgery and relapse for meningiomas in the torcular herophili region.