前床突脑膜瘤的临床和影像学特征分析

Clinical and imaging features of anterior clinoid meningiomas

目的研究前床突脑膜瘤(ACMs)的临床和影像学特征,以及手术效果与影像学分型的关系。方法回顾性分析63例ACMs患者的临床资料,对其临床和影像学表现、肿瘤分型进行分析。患者术前均接受眼科检查评估。结果本组患者的症状以视觉功能障碍最多(49例,77.8%),其中单侧视力下降者占71.4%;以视觉功能障碍为首发症状者占61.9%;视野缺损者占33.3%,其中单侧视野缺损占30.2%,双侧视野缺损仅有3.2%。视神经管受侵袭与术前视力缺损有明显关系。ACMs影像学分型:Ⅰ型7例(11.1%),Ⅱ型39例(61.9%),Ⅲ型5例(7.9%),Ⅳ型12例(19.1%)。肿瘤累及海绵窦者9例(14.3),侵袭视神经管22例(34.9%);包绕前循环动脉39例(61.9%),侵袭前循环血管外膜7例(11.1%)。Ⅰ型患者的肿瘤全切除率仅为14.3%,Ⅱ型患者高达92.3%,Ⅲ型患者为80%,Ⅳ型患者的肿瘤切除程度(全切除率50%)取决于肿瘤与前循环血管的关系。结论单侧视觉功能障碍是ACM最常见的症状和首发症状。术前明确肿瘤是否侵入视神经管和海绵窦,有助于制定个体化手术方式、预测手术疗效、降低手术风险;而ACMs切除程度与肿瘤分型有密切的关系。

Objective To study the clinical and imaging features of anterior clinoid meningiomas(ACMs),and the relationship between surgical effect and imaging classification.Methods The clinical data of 63 patients with ACMs were analyzed retrospectively.All patients underwent ophthalmic examination and evaluation before operation.Results Visual dysfunction was the most common symptom in this group(49 cases,77.8%),of which unilateral visual impairment accounted for 71.4%.Visual dysfunction was the initial symptom in 61.9%.Visual field defect accounted for 33.3%,of which unilateral visual field defect accounted for 30.2%and bilateral visual field defect only 3.2%.The invasion of optic canal was closely related to preoperative visual impairment.ACMS imaging classification showed typeⅠwas in 7 cases(11.1%),typeⅡin 39(61.9%),typeⅢin 5(7.9%),and typeⅣin 12(19.1%).The tumors involved cavernous sinus in 9 cases(14.3%),and invaded optic canal in 22(34.9%).39 cases(61.9%)encased the anterior circulation artery and 7(11.1%)invaded the adventitia of the anterior circulation artery.The total tumor resection rate was only 14.3%in typeⅠpatients,92.3%in typeⅡpatients and 80%in typeⅢpatients.The extent of tumor resection(total tumor resection rate50%)in typeⅣpatients depended on the relationship between the tumor and anterior circulation vessels.Conclusions Unilateral visual dysfunction is the most common and initial symptom of ACMs.Preoperative determination of whether the tumor invades the optic canal and cavernous sinus is helpful to formulate individualized surgical methods,predict surgical efficacy and reduce surgical risk.The extent of ACMs resection is closely related to tumor classification.