显微手术切除颅内大型脑膜瘤(附22例报告)  

作　　者：丁方[1] 朱光耀[1] 戎建东[1] 张剑[1] 张三希[1] 

机构地区：[1]浙江省宁波市医疗中心李惠利医院,315041

出　　处：《浙江临床医学》2005年第3期238-239,共2页Zhejiang Clinical Medical Journal

摘　　要：目的　 结合巨大脑膜瘤的影像学特点和显微外科手术方法 ,探讨提高巨大脑膜瘤全切率及安全性的方法。 方法　 总结我院神经外科 1997年 2月～ 2 0 0 3年 7月采用显微外科手术切除 2 2例颅内各部位大型、巨大型脑膜瘤的治疗经验。其中 ,大脑半球凸面脑膜瘤3例 ,大脑镰旁脑膜瘤 1例 ,矢状窦旁脑膜瘤 5例 ,中颅窝底脑膜瘤 3例 ,枕下脑膜瘤 4例 ,蝶骨嵴脑膜瘤 4例 ,前颅底脑膜瘤 2例。 结果　显微手术全切除 19例 ,次全切除 3例 ,手术无死亡病例。 结论　 采用微创显微外科手术技术 ,可提高颅内脑膜瘤的全切除率 ,减少复发 ,降低手术死亡率 ,提高病人手术后生存质量 ;当肿瘤巨大或肿瘤邻近脑干或重要大血管时 ,肿瘤全切除不可取 ,应考虑次全切除 ,手术后采用伽玛刀处理残留部分肿瘤与颈内动脉、视神经之间有一层蛛网膜结构 ,轻度粘连者容易分离 ,取出肿瘤。如肿瘤较大 ,占据外侧裂池基部 ,不可能开放基底池 ,在这种情况下 ,分离外侧裂 ,暴露肿瘤 ,行囊内切除。蝶骨嵴脑膜瘤可广泛侵袭蝶骨翼 ,并扩展到颅外腔隙 ,难以达到彻底切除 ,80年代以前国内外报道的内侧型蝶骨嵴脑膜瘤全切率不到 5 0 % ,而死亡率可高达2 7% [3 ] 。90年代国内报道的全切率提高至 65 % ,死亡率公认为6.7% [4] ;国外Samii[5]Objective To discuss the method to improve total resection rate of large or huge meningioma safely by radiological features and microsurgical techniques. Methods 22 cases of intracranial large or huge meningiomas treated in our hospital by microsurgery from Feb.1997 to July 2003 were retrospectively reviewed. Tumor located on convexity in 3 cases, parafalceal in 1,parasagittal in 5,middle cranial fossa in 3, suboccipital in 4,sphenoid wing in 4 and front cranial fossa in 2. Results The tumors were totally removed in 19 cases and subtotally resected in 3 cases. There was no mortality in this series. Conclusion Using microsurgical techniques can improve total resection rates of meningioma, reduce recurrence and mortality,and improve quality of life of the patients. Subtotal resection should be performed for tumors for which total resection is impossible. The residual tumour can be treated by radiosurgery.

关 键 词：巨大脑膜瘤 显微手术切除 颅内 肿瘤 显微外科手术 手术后 大脑半球 应考 结论 方法 

分 类 号：R739.4[医药卫生—肿瘤]