经纵裂胼胝体前入路显微全切除鞍膈脑膜瘤(附13例报告)

Microsurgically total removal of diaphragma sellae meningiomas via precallosal interhemis-pheric approach(review of 13 cases)

目的 提高鞍膈脑膜瘤手术全切除率 ,减少术后复发 ,有效治疗和预防术后并发症 ,降低病死率。方法 对 13例患者采用改良手术入路 ,扩大病变部位的暴露范围 ,减少术中因牵拉所造成的脑损害 ,利用显微外科技术在分块切除肿瘤的同时 ,有效保护与病变关系密切的血管、神经、丘脑下部、垂体、垂体柄等重要结构。结果 13例均一次全切除肿瘤 ,随访 1～ 8年 ,无肿瘤复发 ,除 1例术前视力已完全丧失外 ,3例生活自理。 9例均恢复正常。结论 经纵裂胼胝体前切除鞍膈脑膜瘤是较理想的手术入路 ,可一次全切除肿瘤 ,并能有效保护肿瘤周围的重要结构。微侵袭显微外科技术是其必备条件。

Objective To enhance the rate of total removal of the meningiomas of sellar diaphragm, reduce the postoperative recurrence, prevent postoperative complications, reduce the mortality rate.Methods Use the modified surgery approach. Display the tumors maximumly to reduce the injury made by pulling. Protect the adjacent blood vessels,nerves inferior colliculus,hypophysial,manubrium of malleus,while totally remove the tumors microsurgically and fractionatedly.Results Total removal was got in 13 cases.No tumor reccurence with a follow-up ranged from 1 to 8 years.9 cases had resumed their normal work,3 cases could self-care,only one case lost eyesight before operation.Conclusions The interhemispheric neurosurgical approach is ideal.The tumors can be totally removed and the adjacent organs can be protected.Microneurosurgery technique is needed.