外侧型天幕脑膜瘤的显微手术治疗策略  

The microsurgical treatment strategy of lateral tentorial meningioma

作　　者：李冬雪[1] 牛朝诗[1] 凌士营[1] 计颖[1] 姜晓峰[1] 丁宛海[1] 夏成雨[1] 钱若兵[1] 

机构地区：[1]安徽省立医院神经外科,合肥230001

出　　处：《立体定向和功能性神经外科杂志》2017年第2期76-80,共5页Chinese Journal of Stereotactic and Functional Neurosurgery

基　　金：安徽省自然科学基金项目(编号:1508085QH179)

摘　　要：目的探讨外侧型天幕脑膜瘤的显微手术治疗策略。方法回顾性分析2013年4月~2016年11月安徽省立医院神经外科显微手术切除32例外侧型天幕脑膜瘤患者的临床资料、手术方法、肿瘤切除程度、术后并发症及随访情况。结果评价肿瘤切除程度按照Simpson分级标准,I级切除5例,II级切除13例,IV级切除14例。术后病理都是WHO I级,其中过渡型脑膜瘤8例,纤维型脑膜瘤24例。术后出现颅内感染5例;肺部感染1例;术后出血2例,1例为脑内血肿,1例为硬膜外血肿;骨瓣下积液1例;硬膜下积液1例;无术后死亡或重残病例。术后随访患者25例,随访时间2~38个月,10例行伽玛刀治疗,无肿瘤复发。结论充分的术前评估,合理的手术体位、切口和手术入路,娴熟的显微手术技巧特别是对受累静脉窦的处理,术后密切随访及伽玛刀治疗,可以提高外侧型天幕脑膜瘤的疗效,降低治疗风险和复发率。Objective To discuss the microsurgical treatment strategy of lateral tentorial meningioma. Methods Clinical data,surgical approach,extent of the tumor resection,postoperative complications and follow-up of 32 cases with lateral tentorial meningioma during April 2013 to November 2016 in Department of Neurosurgery of Anhui Provincial Hospital were retrospectively analyzed. Results According to Simpson grading criteria,grade I resection was 5 cases,grade II resection was 13 cases,and grade IV resection was 14 cases. Postoperative histopathology by WHO classification reveals that all 32 cases were grade I. 8 cases were transitional meningioma and 24 cases were fibrous meningioma. The complications included 5 cases of intracranial infection after operation,1 case of pulmonary infection,2 cases of postoperative hemorrhage,1 case of bone flap effusion,1 case of subdural effusion,no postoperative death or severe residual cases. The follow-up range from 2 to 38 months in 25 patients and 10 patients received gamma knife. All patient had no recurrence. Conclusion Sufficient preoperative assessment,reasonable surgical position,incision and surgical approach,microsurgery skill especially to handle the affected sinus,close follow-up and necessary gamma knife can improve the curative effect and reduce the risk of recurrence of lateral tentorial meningiomas.

关 键 词：天幕 窦汇 横窦 脑膜瘤 显微手术 

分 类 号：R739.45[医药卫生—肿瘤]