鞍区及鞍旁脑膜瘤35例显微外科治疗体会

Microsurgical treatment of sellar and parasellar meningioma:a review of 35 cases

目的 :总结鞍区及鞍旁脑膜瘤的影像学特点、手术入路及手术效果 ,以提高其治疗效果。方法 :回顾分析 1997年至今收治的 3 5例鞍区及鞍旁脑膜瘤 ,瘤体最大径为 3～ 6.7cm ,平均 5 .3 6cm ,其中单侧额下经纵裂或不经纵裂入路切除 18例 ,采用翼点或扩大翼点入路切除 17例。结果 :肿瘤全切除 (SimpsonⅠ、Ⅱ ) 3 1例 ,近全切除 4例 ,无手术死亡。术后颅高压症状均有缓解 ,18例有视力视野障碍者 ,改善 11例 ,无改变 5例 ,变差 2例。结论 :对于鞍上向前方、上方生长以及鞍内脑膜瘤甚至向蝶窦内生长者 ,可以采用单侧额下经纵裂入路 ;而对于向侧方或后方生长的鞍区脑膜瘤 ,可采用翼点入路或扩大翼点入路 ,两者均能获得良好的肿瘤暴露 。

Objective:To summarize the neuroradiologic features,microsurgical approaches,patients' outcome of sellar and parasellar meningiomas,for improving therapeutic effect.Methods:35 patients with meningioma which originates from tuberculum sellae or diaphragma sellae or internal sphenoidal ridge have been operated on by unifrontal basal interhemispheric approach or enlarged pterion approach. The degree of tumor resection and the patient's outcome were discussed.Results:Total resection(Simpson Ⅰ,Ⅱ)had been performed on 31 patients, the other 4 patients were processed by subtotal resection,with no death perioperatively. After operation,the intracranial hypertension was relieved,and 11 of 18 patients who had disturbance in visual acuity and visual field were obviously improved,2 became worse and the other 5 had no change.Conclusion:Unifrontal basal interhemispheric approach or enlarged pterional approach can treat nearly all the meningiomas in sellar and parasellar region.Both of the approach can obtain good esposure.The total incised rate is higher.