显微外科手术治疗窦汇区脑膜瘤35例分析  

Microsurgical treatment of confluens sinus meniongiomas

作　　者：牛建星[1] 王建祯[1] 杜长生[1] 胡俊峰[1] 赵善敏 李学真[2] 

机构地区：[1]中国人民武装警察部队总医院神经肿瘤外科,北京100039 [2]首都医科大学附属北京天坛医院神经外科,北京100050

出　　处：《中国医刊》2014年第5期44-47,共4页Chinese Journal of Medicine

摘　　要：目的总结窦汇区脑膜瘤的显微外科治疗技巧及临床疗效。方法回顾性分析35例经显微外科治疗及病理证实的窦汇区脑膜瘤资料,根据术前MRI确定肿瘤基底及生长范围并设计手术入路。结果27例达SimponⅠ级切除；5例达SimponII级切除；3例做肿瘤近全切除,残存窦腔内少许肿瘤,达SimponⅣ级切除。术后3例进行伽玛刀治疗。本组患者无手术死亡病例,无相关手术并发症致残。32例患者随访1~5年,平均3年,1例术后2年复发（ SimponⅣ级切除）,2例术后3年复发（1例Ⅰ级切除和1例SimponⅡ级切除）。结论术前应做头颅磁共振静脉血管成像明确肿瘤与静脉窦关系及静脉窦通畅情况；根据MRI提示肿瘤的生长范围设计手术入路,术中根据需要充分暴露受累静脉窦,在保留静脉窦通畅的前提下,选择合理的手术入路及娴熟的显微外科技巧是手术成功的关键。伽玛刀是治疗窦汇区脑膜瘤的有益辅助手段。Objective To investigate the microsurgical technique and efficacy for confluens sinus meniongiomas. Method Clinical data,managements of microsurgical treatment and surgical efficacy of 35 cases with confluens sinus meniongiomas during 2008 to 2013 were retrospectively analyzed. The surgical approach was designed by the position of tumor basement and the direction of tumor growth. Result Simpson GradeⅠwas achieved in 27 patients. Simpson Grade II was achieved in 5 patients,and GradeⅣwas achieved in 3 patients in which a subtotal resection of tumor was performed with part of tumor remnant left in the sinus lumen givenγ-knife radiosurgery after microsurgery. There was no operative mortality or severe complications. The 32 patients were followed up systematically for 1 to 5 years with a mean follow-up period of 3 years. 1 patient with Simpson Grade Ⅳ recurrence 2 years after the operation,2 patients with Simpson GradeⅠand Simpson Grade II recurrence 3 years after the operation. Conclusion In front of the microsurgery ought to do MRV is clear about the tumor and the venous sinus relations and the venous sinus un-obstructed situation. According to MRI prompt tumor growth scope design operative approach. In the microsurgery ac-cording to needs to expose fully exhausts oneself the venous sinus, under the retention venous sinus unobstructed premise,chooses the reasonable operative approach and the adept microsurgery technology skill is the key which the surgery succeeds. Gamma knife is a useful adjunct to the treatment of confluens sinus meningiomas.

关 键 词：窦汇区 脑膜瘤 显微外科手术 

分 类 号：R651.1[医药卫生—外科学]