包裹颈内动脉巨大蝶鞍区脑膜瘤的外科治疗

Surgical treatment of giant sphenoidal-sellar region meningioma encapsulating internal carotid artery

目的探讨和总结包裹颈内动脉巨大蝶鞍区脑膜瘤的临床显微外科手术技巧及疗效。方法回顾性分析2008年5月~2016年5月收集的19例包裹颈内动脉巨大蝶鞍区脑膜瘤患者的临床资料,其中男7例,女12例;年龄34~68岁,平均年龄56.5岁,发病时间11个月至6年,所有患者均经额颞入路行脑膜瘤切除。结果19例包裹颈内动脉巨大蝶鞍区脑膜瘤中SimpsonⅡ级切除15例,Ⅲ级切除4例。无一例死亡。术后随访2~8年,平均随访时间6.5年,无一例肿瘤复发。术后发生可恢复性脑梗塞6例,经对症治疗术后3个月内症状明显改善或消失,3例出现不可恢复性脑梗塞,术后1年仍无改善。结论包裹颈内动脉巨大蝶鞍区脑膜瘤手术风险极大,预判颅底重要解剖结构,沿神经血管走形锐性分离,术中避免颈内动脉破裂出血和术后积极预防血管痉挛,能够获得较好的手术疗效。

Objective To investigate and summarize the clinical microsurgical skills of giant sphenoidal-sellar region meningioma encapsulating internal carotid artery so as to improve the therapeutic effect. Methods Clinical data of 19 patients who underwent removal of giant sphenoidal-sellar region meningioma encapsulating internal carotid artery in our department from May 2008 to May 2016 were analyzed retrospectively. Of them, 7 were male and 12 were female, with an age range of 34 to 68 years （ average age 56.5 years ） and disease duration ranged from 11 months to 6 years. Tumor resection was performed in all 19 patients via frontal-temporal approach. Results Simpson Grade 11 resection was achieved in 15 cases and Simpson grade Ill resection in 4 with no deaths. All the patients had been followed-up postoperatively for 2 to 8 years with an average of 6.5 years. No tumor recurrence occurred. In 6 patients, recoverable cerebral infarction occurred and got improved or disappeared within three months after operation. However, 3 cases with unrecoverable cerebral infarction had no improvement one year after the operation. Conclusion With significant risks, prejudgement of the important anatomical structures at the skull base, sharp separation along neurovascular course, avoidance of intraoperative rupture of internal carotid artery and prevention of postoperative vasospasm are essential for good therapeutic effect in the surgical treatment of giant sphenoidal-sellar region meningioma encapsulating internal carotid artery.