经翼点入路鞍上脑膜瘤的手术并发症及预防

Complications of Surgery through Pterional Approach for Suprasellar Meningiomas and Their Prevention

目的探讨经翼点入路显微手术切除鞍上脑膜瘤的常见并发症及相关因素,总结其预防方法。方法回顾性分析160例鞍上脑膜瘤的临床资料。结果160例鞍上脑膜瘤全切141例(88.1%),次全切19例(11.9%),视神经功能改善125例(78.1%),垂体柄保留155例(96.8%);主要并发症包括视力恶化(7.5%),尿崩(16.9%),电解质紊乱(8.8%),偏瘫(3.8%)等。手术死亡1例(0.6%),复发3例(2.5%)。结论熟悉鞍区的显微解剖和熟练掌握显微外科技术是减少手术并发症的关键,术中须沿肿瘤周围的蛛网膜界面分离和切除肿瘤,仔细辨认并保护好向视器、垂体柄、下丘脑供血的穿支动脉。

Objective To explore the common complications related to the operation through the pterional approach for resection of suprasellar meningiomas and their preventive measaures. Method The clinical data of 160 patients with suprasellar Meningiomas treated by microsurgical surgery through pterional approach were analyzed retrospectively. Results Of 160 patients with suprasellar meningiomas, 141 received total resection of the tumors (88.1%) and 19 subtotal (11.9%). The function of optic nerves was improved in 125 patients (78.1%). Pituitary stalks were preserved in 155 cases (96.8%). The major complications included visual deterioration (7.5%), dibates insipidus (16.9%), electrolyte disorder (8.8%), hemiparesis (3.8%). 1 case (0.6%) died postoperatively. The meningiomas recurred in 3 cases (2.5%) after 2 years. Conclusions It is the key to decreasing the complications to know the microsurgical anatomy of sellar region and to master microsurgical technique. It is especially noted that the tumor must be dissected and removed through the arachnoid interface between tumor and adjacent structures, and the visual apparatus, pituitary stalk and the small arteries feeding to hypothalamus must be carefully protected.