天幕脑膜瘤侵犯静脉窦的处理措施  

Treatment measures for tentorial meningiomas invading the venous sinus

作　　者：孙永谋 李健[1] 苏贺先[1] SunYongmou Li Jian Su Hexian(Department of Neurosurgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233000, Chin)

机构地区：[1]蚌埠医学院第一附属医院神经外科,233000

出　　处：《中国微侵袭神经外科杂志》2017年第6期268-271,共4页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的探讨天幕脑膜瘤侵犯静脉窦的处理措施。方法回顾性分析显微外科手术治疗的侵及横窦、乙状窦的20例脑膜瘤的临床资料,采用旁正中入路11例,后正中入路4例,幕上下联合入路1例,乙状窦后入路2例,Poppen入路2例。结果达肿瘤SimpsonⅠ级切除8例,SimpsonⅡ级切除9例,SimpsonⅢ级切除3例。术后病理:纤维型11例,上皮型5例,非典型性3例,乳头样型1例。术后严重脑肿胀1例,颅内感染1例。随访3~48个月,恢复正常工作和生活15例,生活基本自理2例,复发2例予伽玛刀治疗,轻度小脑功能障碍1例;本组无死亡病例。结论对侵犯横窦、乙状窦脑膜瘤,妥善处理窦壁及窦内肿瘤可减少术后并发症,降低复发率。Objective To explore the treatment measures for tentorial meningiomas invading the venous sinus. Methods Clinical data of 20 patients with meningiomas invading transverse sinus or sigmoid sinus undergoing microsurgery were analyzed retrospectively, The surgical approaches adopted included paramedian approach in II patients, posterior midline approach in 4, combined supratentorial- infratentorial approach in 1, retrosigmoid approach in 2 and Poppen approach in 2. Results Simpson grade I tumor resection was -chieved in 8 patients, Simpson grade l] resection in 9 and Simpson grade llI resection in 3. Postoperative pathological findings were as follows： fibrous type in 11 patients, epithelial type in 5, atypical type in 3 and papillary type in I. Severe brain swelling occurred in 1 patient and intracranial infection in 1 after the operation. During a follow-up period of 3 to 48 months, 15 patients returned to normal work and life activities, 2 were able to take care ofthemself in daily life, 2 recurred and received gamma knife treatment and 1 was found to have mild cerebellar dysfunction. No patient died. Conclusion Properly treat the sinus wall tumor and intrasinus tumors can reduce postoperative complications and decrease the recurrence rate in patients with meningiomas invading the transverse sinus and sigmoid sinus.

关 键 词：脑膜瘤 天幕 横窦 乙状窦 显微外科手术 

分 类 号：R739.45[医药卫生—肿瘤] R651.11[医药卫生—临床医学]