蝶窦海绵窦脑膜瘤术后眼睑下垂相关因素及并发症分析  

Results and complications of sphenocavernous meningiomas with special reference to postoperative ptosis

作　　者：郝淑煜[1] 张俊廷[1] 张力伟[1] 谢琳[1] 吴震[1] 贾桂军[1] 汤劼[1] 肖新如[1] 耿素民[1] 王亮[1] 

机构地区：[1]首都医科大学附属北京天坛医院神经外科中心,100050

出　　处：《中华神经外科杂志》2011年第1期18-22,共5页Chinese Journal of Neurosurgery

基　　金：首都医学发展科研基金（2007-2064）

摘　　要：目的 分析蝶窦海绵窦脑膜瘤显微手术术后眼睑下垂相关因素及并发症.方法 回顾性研究首都医科大学附属北京天坛医院颅底脑干病房从1993年4月到2008年12月的49例蝶窦海绵窦脑膜瘤的治疗情况,对可能导致术后眼睑下垂的危险因素进行Logistic回归分析.结果 男41例,女38例;平均年龄52.4岁;病史平均20.9个月.最常见症状为脑神经损害,MRI发现肿瘤平均最大径为5.09 cm.30例患者采用额颞人路,14例采用额颞断颧弓人路,5例选用眶颧入路切除肿瘤.肿瘤近全切除率52%,死亡率2%.随访到39例患者,平均随访73.7个月,4例随访中死亡,生存的35例患者中,22例正常生活.多因素分析发现,术后眼睑下垂与海绵窦分级、术前KPS评分及既往手术史相关.结论 蝶窦海绵窦脑膜瘤全切困难,术后最常见并发症是动眼神经麻痹,术后眼睑下垂与海绵窦分级、术前KPS评分及既往手术史相关.术后随访发现肿瘤复发可辅助放疗.Objective To study the surgical results and complications for sphenocavernous （SC）meningioma patients with special reference to postoperative ptosis.Method 49 consecutive cases of SC meningiomas operated between April 1993 and Dec 2008 in our department were reviewed.All the probable risk factors related to postoperative ptosis were studied with Logistic regression analysis.Results There were 38 female and 11 male patients （ mean age 52.4 years, range 31 ～ 74 years）.The mean duration of symptoms was 20.9 months（ ranging from 1 week to 108 months）.Cranial nerves palsy was the most common presenting symptoms.The mean maximal diameter of tumor on MRI was 5.09 cm.Frontotemporal approach was performed in 30 cases,frontotemporal zygomatic approach in 14 cases and frontotemporal orbitozygomatic osteotomy approach in 5 cases.Subtotal resection was achieved in 52% patients.The surgical mortality was 2%.Follow -up data were available for 39 patients,with a mean follow- up of 73.7 months.Four patients died during follow - up period.Of the 35 living patients, 22 lived a normal life.Multi - factors that might influence ptosis after operation included the grading of cavernous extension, pre - operation KPS and the history of surgery for tumors.Conclusions Complete and safe resection of SC meningioma is difficult.Our experience suggests that the most common complication after SC meningioma surgery is ocular CN dysfunction.The factors relative to postoperative ptosis include the extension to cavernous sinus,pre - operation KPS and history of surgery for meningioma.Gamma knife radiosurgery could be considered as an adjuvant therapy only for recurrent tumors during follow - up period.

关 键 词：并发症 脑膜瘤 显微外科手术 蝶窦海绵窦 眼睑下垂 

分 类 号：R739.45[医药卫生—肿瘤]