巨大型嗅沟脑膜瘤的显微手术策略

Microneurosurgical strategies for giant olfactory groove meningiomas

目的 探讨巨大型嗅沟脑膜瘤(OGMs)(最大径≥6 cm)的显微手术切除策略及临床疗效。方法 回顾性分析2015年1月—2021年12月南京医科大学附属脑科医院收治的12例巨大型OGMs患者的临床资料。所有患者均行额底入路,按照改良的手术策略和步骤切除肿瘤。结合术中及术后增强MRI,采用Simpson分级评估肿瘤的切除程度。采用Karnofsky功能状态评分评估术后1~3个月的功能状态。结果 12例患者中,SimpsonⅡ级切除11例(91.67%),Ⅲ级切除1例(8.33%)。术后CT和MRI提示,肿瘤切除完全,周围脑组织无明显挫伤出血,与术前相比瘤周水肿无明显增大。所有患者颅内增高症状、精神障碍及视力障碍,术后均有明显改善;无脑脊液漏、感染和严重并发症。术后1个月KPS评分均为90~100分。随访6个月~4年未见肿瘤复发。结论 双侧额底入路是处理巨大型OGMs的经典入路。通过改良手术处理策略和技术,可以更安全地切除肿瘤,保护额叶,识别保护重要的神经血管结构,降低手术风险和并发症。

Objective To investigate the microsurgical resection strategies and clinical efficacy of giant olfactory groove meningiomas(OGMs)(maximum diameter≥6 cm).Methods The clinical data of 12 patients with giant OGMs admitted to the Affiliated Brain Hospital of Nanjing Medical University were analyzed retrospectively.All patients underwent frontal basal approach,and tumors were removed via the modified surgical strategies and procedures.The Simpson grading was applied to evaluate the degree of resection in combination with intraoperative findings and postoperative MRI with enhencement.The KPS was used to evaluate the patient outcome at 1-3 months after surgery.Results Of 12 patients,11(91.67%)achieved SimpsonⅡgrade resection,and 1(8.33%)achieved SimpsonⅢgrade resection.Postoperative CT and MRI showed the tumor was resected completely.There was no obvious contusion and bleeding in the surrounding brain tissue,and the peritumoral edema did not increase significantly compared with that preoperative.All patients who were with symptoms of increased intracranial pressure,mental disorders and visual deficits relieved significantly after operation.There were no cerebrospinal fluid leakage,infection and serious complications.All patients KPS were 90-100 at 1 month after surgery.No tumor recurrence was observed during 6 months to 4 years of follow-up.Conclusions The bifrontal basal approach is a classic approach for giant OGMs.Adherence to the modified surgical strategies and techniques,the tumor can be resected safely,the frontal lobe can be protected well,and the vital neurovascular structures can be identified and protected intactly.Therefore,the surgical risks and complications can be reduced.