经颞顶直切口皮质造瘘术在切除侧脑室三角区脑膜瘤中的应用

Ventriculostomy through straight-incision temporoparietal approach for the resection of meningioma at the trigone of lateral ventricles

目的初步探讨经颞顶直切口皮质造瘘术在切除侧脑室三角区脑膜瘤中的应用效果。方法回顾性分析山东大学齐鲁医院神经外科2015年1月至2017年6月采用经颞顶直切口皮质造瘘手术治疗22例侧脑室三角区脑膜瘤患者的临床资料。根据患者的术中情况、术后影像学资料及其主要并发症评价该术式在切除侧脑室三角区脑膜瘤中的可靠性及优势。结果22例侧脑室三角区脑膜瘤均达到SimpsonⅠ级切除。手术时长为(140±75)min(60~240 min),术中出血量为(300±110)ml(20~800 ml),术中均未输血。开关颅的总时长为(20±4)min(14~31 min),开关颅阶段的出血量均<20 ml。其中1例(4.5%)患者术后出现脑室内出血,行腰穿置管引流治疗后恢复良好,无死亡病例。术后随访(16±7)个月(6~30个月),影像学复查未见肿瘤复发的病例。结论经颞顶直切口皮质造瘘手术可在有效显露和最大程度安全切除侧脑室三角区脑膜瘤的同时,减少对神经血管的损伤,节省手术时间,可作为侧脑室三角区脑膜瘤手术治疗的常规术式。

Objective To explore the application of ventriculostomy through straight-incision temporoparietal approach in the resection of meningioma at the trigone of lateral ventricles.Methods A total of 22 patients underwent operation through the straight-incision temporoparietal approach at Department of Neurosurgery,Qilu Hospital of Shandong University from January 2015 to June 2017 and were enrolled into this study.By retrospectively analyzing the intraoperative conditions,postoperative imaging,common complications of patients,we evaluated the reliability and advantages of the operative technique in the treatment of meningioma at the trigone of lateral ventricles.Results SimpsonⅠresection was achieved in all 22 patients without death.The operation duration was 140±75 min(60-240 min)and intraoperative blood loss was 300±110 ml(20-800 ml).The total time spend on craniotomy was about 20±4 min(14-31 min),and the blood loss during skull opening and closing periods was<20 ml.One patient(4.5%)developed postoperative intraventricular hemorrhage and good recovery was achieved with lumbar drainage.There was no imaging recurrence during the follow-up lasting for 16±7 months(6-30 months).Conclusion Being able to make effective exposure for maximal safe resection of meningioma at the trigone of lateral ventricles,the straight-incision temporoparietal approach could reduce damage to the vessels and nerves and shorten operative time,which might thus be used as a routine surgical treatment of meningioma at the trigone of lateral ventricles.