天幕脑膜瘤的显微手术治疗  

Microsurgical treatment of tentorial meningiomas

作　　者：陈靖[1] 蒋宇钢[1] 彭雍[1] 张凌云[1] 田伟[1] 

机构地区：[1]中南大学湘雅第二医院神经外科,湖南长沙410011

出　　处：《中华神经外科疾病研究杂志》2009年第3期260-263,共4页Chinese Journal of Neurosurgical Disease Research

摘　　要：目的探讨天幕脑膜瘤的临床特点、手术入路及显微手术技巧。方法回顾性分析我院2003年1月至2008年6月期间收治的39例天幕脑膜瘤患者的临床资料。依据肿瘤基底附着部位和主体生长方向选择不同的手术入路,其中31例普通型天幕脑膜瘤经单侧枕下入路12例,经颞枕或枕部入路7例,经枕下乙状窦后入路5例,经枕下正中入路4例,经幕上下联合入路3例;8例天幕游离缘脑膜瘤中,经枕-天幕入路5例,经改良翼点入路2例,经幕下小脑上入路1例。结果肿瘤达SimpsonI级全切除19例(48.7%),II级全切除17例(43.6%),次全切除2例(5.1%),大部分切除1例(2.6%),无手术死亡。对37例患者进行了随访,随访时间4个月至5年,28例(75.7%)恢复正常生活,7例(18.9%)生活完全自理,2例(5.4%)生活需他人帮助。结论天幕脑膜瘤应积极手术治疗。适宜的手术入路及精细的显微外科技巧,可显著提高肿瘤全切率,减少复发,降低并发症。Objective To investigate the clinical manifestation, operative approach and nlierosurgical technique of surgery for tentorial meningiomas. Methods Thirty-nine cases of tentorial meningiornas treated with microsurgery from January 2003 to June 2008 were analyzed retrospectively. In the patients with ordinary tentorial meningiomas, 12 cases were operated via the unilateral suboccipital approach, 7 cases via the temporal-occipital or occipital approach, 5 cases via the retrosigrnoid approach, 4 cases via middle suboccipital approach and 3 cases via combined supratentorial and infratentorial approach. Five patients with meningiomas of tentorial notch were operated via occipital-tentorial approach, 2 cases via modified pterion approach and one via infratentorial supracerebellar approach. Results In the series of the patients, 19 cases were Simpson grade I, 17 were Simpson grade II, 2 of subtotal resection, and 1 of partial resection without surgical mortality. Thirty-seven patients were followed-up from four months to five years. During the follow-up period, 28 patients resumed work and normal life, 7 patients obtained self care capability, and 2 patients needed to be taken care of. Conclusion Tentorial meningiorna is amenable to aggressive surgery. Fine therapeutic efficacy and low disability rate can be obtained by microsurgical techniques to resect tentorial meningiomas with appropriate surgical approach and elaborate microneurosurgical skills.

关 键 词：脑膜瘤 天幕 显微外科手术 

分 类 号：R739[医药卫生—肿瘤]