大型嗅沟脑膜瘤外科治疗:附18例报告  

Surgical Treatment of Large Olfactory Groove Meningiomas

作　　者：钱忠心[1] 赵鸿[1] 朱景伟[1] 赵明珠[1] 叶树铭[1] 龚良[1] 丁勇[1] 张宇一[1] 刘卫东[1] 

机构地区：[1]上海市浦南医院神经外科,上海200125

出　　处：《中国神经肿瘤杂志》2010年第2期105-108,共4页Chinese Journal of Neuro-Oncology

摘　　要：背景与目的:目前对嗅沟脑膜瘤的治疗方法已较成熟,但对大型肿瘤患者的手术处理仍存在一定难度。本文拟探讨手术治疗大型嗅沟脑膜瘤的操作技术与经验。方法:回顾性总结2000年1月至2009年1月间在本科经手术治疗的18例大型(肿瘤最大径>5cm)嗅沟脑膜瘤患者的临床资料并进行分析。所有患者术前常规行头颅X线平片、CT及MRI检查,有10例患者同时进行了肿瘤CT血管成像扫描检查,4例患者行DSA检查。全部患者均行手术治疗,采用双额骨瓣开颅,矢状窦前部结扎经前纵裂入路,8例患者术中行腰池置管,术中使用双频射频器行肿瘤内分块切除,同时辅以神经导航系统帮助术者动态了解操作部位与肿瘤周边重要组织结构的位置关系。结果:18例患者中手术切除肿瘤达到SimpsonⅠ级10例,Ⅱ级8例。无死亡及新的神经功能缺损发生,1例术后发生脑脊液鼻漏,2例发生明显皮下积液,其中1例继发硬膜外感染,3例经处理后均治愈。14例得到1～8年随访,1例在随访期间MRI显示肿瘤有复发而行放射治疗,其余患者均未见肿瘤复发。结论:双额骨瓣前纵裂入路仍是治疗大型嗅沟脑膜瘤理想的手术入路。术前行肿瘤CT血管成像检查以及术中辅以神经导航技术对重要的血管神经及脑组织的保护具有良好的帮助作用。BACKGROUND OBJECTIVE：Surgical resection is the mainstay in the management of olfactory groove meningiomas.In this study,we investigated the operative technique and experience for surgical treatment of large olfactory groove meningiomas.METHODS：The clinical data of 18 patients with large olfactory groove meningiomas（tumor＇s diameter more than 5cm）were treated by microsurgery from January 2000 to January 2009 were analyzed retrospectively.Before operation all patients were undergone cranial X-ray、CT and MRI examinations,10 of them were taken tumor CT angiography study and 4 were taken DSA study.All the patients were received surgical treatment through coronal skin flap,bilateral frontal bone window,anterior longitudinal approach.Lumbar puncture was performed in 8 patients during the operation.The tumors were resected the tumor with the assistance of dual radio frequency piece by piece and navigation instruments in order to confirmed the adjacent anatomical structures during the operation.RESULTS：Of 18 paitents,Simpson Ⅰresection was achieved in 10 cases and Simpson Ⅱresection in 8 cases respectively.No patient died and no new neurological dysfunction occurred.CSF leakage was observed in 1 patient.Two patients had subcutaneous hydrops under,one of whom had secondary epidural infection,all the patients were cured after treatment.Fourteen patients were followed up from 1 to 8 years,among whom only 1 patient showed tomur recurrence on following MRI and received further radiotherapy.No recurrence in the other cases.CONCLUSIONS：With coronal skin flap and bilateral frontal bone window,the anterior longitudinal approach is an ideal operative approach to treat the large olfactory groove meningiomas.Preoperative tumor CT angiography and intraoperative real-time navigation are useful and helpful to protect the brain vessels and nerves.

关 键 词：嗅沟脑膜瘤 手术 

分 类 号：R739.41[医药卫生—肿瘤]