前颅窝底巨大脑膜瘤的显微手术治疗

Microsurgical Treatment of Huge Meningiomas at Anterior Skull Base

目的:总结前颅窝底巨大脑膜瘤的手术入路和切除方式,并分析特殊类型脑膜瘤的手术治疗方法。方法:回顾性分析2012至2014年间我科收治的21例前颅窝底巨大脑膜瘤病例的临床资料、手术经过及预后情况。结果:所有病例经影像学检查,并行显微手术治疗,肿瘤全切除(SimpsonⅠ、Ⅱ级切除)18例,近全切除3例,无死亡病例;除1例颅神经功能术前完全丧失外,术后神经功能改善者17例,无改善者2例,加重者1例。术后随访复查头颅MRI,肿瘤全切除组病例未见复发,近全切除有2例复发。结论:前颅窝底巨大脑膜瘤手术切除难度大,根据肿瘤部位选择正确手术入路,采用精细的显微外科技术,可取得良好的手术效果。

Objective:To explore the operative approach and mode for resecting huge meningiomas at anterior skull base and to analyze the operative strategy of the special meningioma.Methods:The clinical data,microsurgical operative process,curative effects and prognosis of 21 cases with huge meningiomas at anterior skull base admitted to our department between 2009 and 2012were reviewed and analyzed by retrospective analysis.Results:All cases accepted microsurgery and then survived.Among them,total removal was achieved in 18cases(Simpson gradeⅠ,Ⅱ),and subtotal removal in 3cases.After surgery,neurological function was improved in 17 cases,no significant changes in two and deterioration in one,except the other one case who totally lost functions of cranial nerves before operation.Furthermore,no recurrence in groups of gradeⅠ and gradeⅡresection,and two cases of recurrence in the group of subtotal resection were observed by MRI scan at the follow-up visit.Conclusion:Although it is very difficult to remove the huge meningioma at anterior skull base,agood outcome also could be obtained through correct choice of a suitable operative approach,and microsurgical techniques,as well as careful protection of important vessels and nerves.