经枕部纵裂入路切除松果体区脑膜瘤的疗效分析

Efficacy analysis of resection of pineal region meningiomas through occipital interhemispheric approach

目的观察经枕部纵裂入路切除松果体区脑膜瘤的疗效。方法回顾性分析2010年5月至2021年11月空军军医大学第一附属医院神经外科采用经枕部纵裂入路显微手术治疗的10例松果体区脑膜瘤患者的临床资料。肿瘤最大直径为(4.4±1.4)cm(2~7 cm);幕-镰交界区脑膜瘤9例,中间帆型脑膜瘤1例。Bassiouni分型Ⅰ型4例、Ⅱ型4例、Ⅲ型1例、Ⅳ型1例。评估肿瘤的切除程度和术后并发症。结果10例患者共接受了11例次手术,SimpsonⅠ级切除1例次、Ⅱ级9例次、Ⅳ级1例次。术后发生短暂性同向偏盲3例,1周内均恢复;其中1例有轻偏瘫,术后3个月恢复。10例患者的中位随访时间为38个月(4个月至12年)。无一例患者肿瘤复发及死亡,末次随访Karnofsky功能状态评分≥80分8例,50~70分2例。结论经枕部纵裂入路显微手术切除松果体区脑膜瘤,通过枕部纵裂切开小脑幕或大脑镰,可有效地显露占据小脑幕下空间的肿瘤,肿瘤切除程度较高,并发症较少。

Objective To assess the efficacy of resection of pineal region meningiomas through occipital interhemispheric approach.Methods We retrospectively reviewed the clinical records of 10 patients with pineal region meningiomas who underwent microsurgical resection via occipital interhemispheric approach between May 2010 and November 2021 at the Department of Neurosurgery of the First Affiliated Hospital of Air Force Military Medical University.The maximum tumor diameter was 4.4±1.4 cm(2-7 cm).Among the 10 patients,there are 9 cases of falcotentorial meningiomas and 1 case of velum interpositum meningioma.According to the Bassiouni classification system,there are 4 cases of typeⅠ,4 cases of typeⅡ,1 case of typeⅢand 1 case of typeⅣ.Extent of resection and postoperative complications were also assessed.Results Ten patients with pineal meningioma underwent 11 surgical operations.Of the 11 operations,9 were Simpson gradeⅡresection,1 was gradeⅠand 1 was gradeⅣ.Transient homonymous hemianopia occurred in 3 patients after operation and recovered in 1 week.One patient had hemiparesis,which resolved by 3 months.No patient suffered from tumor recurrence or died,with a median follow-up of 38 months(4 months to 12 years).At the last follow-up,the KPS score was≥80 in 8 cases and 50-70 in 2 cases.Conclusion Through the occipital interhemispheric approach,the pineal region meningiomas occupying the infratentorial space can be accessed effectively by opening the tentorium or the falx cerebri.The degree of tumor resection is relatively high with few complications.