老年功能区矢状窦旁巨大脑膜瘤的显微手术治疗

Microsurgical resection of giant para-sagittal meningioma in the functional area in the elderly

目的探讨显微手术切除老年矢状窦旁巨大脑膜瘤的临床效果。方法对2014年1月至2018年6月显微手术治疗的32例年龄>60岁[中位年龄(63.4±2.5)岁,最大年龄78岁]、累及功能区皮层的矢状窦旁巨大脑膜瘤(瘤径>5 cm)患者的临床资料进行回顾性分析,了解神经电生理监测联合显微外科技术的手术效果,总结治疗方法及手术技巧。结果术前合并高血压11例、冠心病5例、糖尿病8例、颅内血管狭窄4例、脊髓空洞2例,无合并症2例;手术全程进行运动/感觉诱发电位监测;Simpson Ⅰ级切除11例,SimpsonⅡ级切除9例(其中2例为复发脑膜瘤),Simpson Ⅲ级切除9例(其中3例为复发脑膜瘤),Simpson Ⅳ级切除3例(其中2例为复发脑膜瘤)。对WHO病理分级II级、Ⅲ级和肿瘤残留、肿瘤细胞呈增生活跃状态的I级脑膜瘤,术后常规进行放射治疗。随访4~43个月,其中1例随访11个月时复发,再次手术后辅助放射治疗。无手术死亡病例。术前以偏瘫、偏身感觉障碍为主要表现14例,经治疗后恢复12例,术前无偏瘫术后出现偏瘫3例,其中1例并发肺炎,治疗后在7~21 d内恢复;以癫痫为主要症状8例患者术后口服抗癫痫药物,均未再出现癫痫发作。结论显微手术切除功能区老年矢状窦旁巨大脑膜瘤,术中强调使用神经电生理监测技术,保护功能区皮层组织和引流静脉;老年患者术后并发症多,影响术后整体治疗质量,围手术期必须高度重视合并症和并发症的防治。

Objective To investigate the clinical efficacy of microsurgery in the resection of giant para-sagittal meningioma in the elderly. Methods The clinical data of 32 elderly patients with giant meningioma(diameter >5 cm) involving the cortex of the functional area treated with microsurgery in our hospital during Jan. 2014 and Aug. 2018 were retrospectively analyzed. The patients aged >60 years(mean 63.4±2.5 years, maximum 78 years). The clinical outcomes and surgical skills were summarized. Results Hypertension was detected in 11 cases, coronary heart disease in 5 cases, diabetes mellitus in 8 cases, intracranial vascular stenosis in 4 cases, syringomyelia in 2 cases, and 2 cases had no complications. Motor/sensory evoked potentials were monitored throughout the operation. Simpson Ⅰ resection was performed in 11 cases, Simpson Ⅱ resection in 9 cases(2 cases were recurrent meningioma), Simpson Ⅲ resections in 9 cases(3 cases were recurrent meningioma), and Simpson Ⅳ resection in 3 cases(2 cases were recurrent meningioma). Patients with WHO Ⅱ tumor, WHO Ⅲtumor, residual tumor, or meningioma with active proliferative tumor cells received radiotherapy after operation. During the follow-up of 4-43 months, 1 case had relapse in month 11 and recov-ered after a second operation and adjuvant radiotherapy. In no-death cases during operation, 14 manifested with hemiplegia and hemidysesthesia, in which 12 recovered;3 cases developed hemiplegia, 1 of which was complicated with pneumonia, and recovered after 7-21 days;8 patients with epilepsy took antiepileptic drugs and no seizure recurred. Conclusion In the microsurgical excision of giant para-sagittal meningioma in elderly patients, the protection of cortex and drainage veins in functional area is very important. As the complications affect clinical outcomes, due attention should be paid to the perioperative comorbidities and complications.