经翼点入路显微外科手术治疗大型鞍旁脑膜瘤34例临床经验  

Microsurgical treatment of large parasellar meningiomas by pterional craniotomy: a clinical experience with 34 cases

作　　者：张敬泉[1] 迟风令[1] 洪波[2] ZHANG Jing-quan;CHI Feng-ling;HONG Bo(Department of Neurosurgery,Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine,Shanghai 200137,China;Department of Neurosurgery,Changhai Hospital,Navy Medical University(Second Military Medical University),Shanghai 200433,China)

机构地区：[1]上海中医药大学附属第七人民医院神经外科,上海200137 [2]海军军医大学(第二军医大学)长海医院神经外科,上海200433

出　　处：《第二军医大学学报》2018年第4期455-459,共5页Academic Journal of Second Military Medical University

摘　　要：目的总结分析经翼点入路治疗大型鞍旁脑膜瘤的显微外科手术方法及其疗效。方法回顾性分析2006年7月至2016年8月间上海中医药大学附属第七人民医院收治的接受翼点或扩大翼点入路显微外科手术的34例大型鞍旁脑膜瘤患者的临床资料,其中男性13例、女性21例;年龄21~72岁,平均(49±13)岁;病程1~55个月,平均(13±10)个月;瘤体最大直径为3.3~5.2 cm,平均(4.3±0.6)cm。结果本组无手术死亡患者。术后头颅影像学检查示,34例患者中肿瘤全切者24例、次全切者5例、部分切除者5例。术后随访时间为24~48个月,平均(36±13)个月。预后优良者28例(Karnofsky评分为80~100分),预后一般者6例(Karnofsky评分为60~79分)。5例患者术后发生动眼神经麻痹,给予营养神经处理后症状好转。结论翼点或扩大翼点入路显微外科手术可以提高肿瘤切除率。对于无法实施全切的肿瘤,可行大部手术切除后辅以放射治疗以提高疗效。Objective To introduce the microsurgery treatment method for large parasellar meningiomas by pterional craniotomy and its curative effect.Methods The clinical data of 34 patients with large parasellar meningiomas,who underwent microsurgery via pterional or extensive pterional craniotomy in Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine Jul.2006 to Aug.2016,were retrospectively analyzed.The patients included 13 men and 21 women with ages ranging from 21 to 72(average,49±13)years old.The course of disease ranged from 1 to 55(average,13±10)months.Maximum diameter of tumors ranged from 3.3 to 5.2(average,[4.3±0.6])cm.Results No surgical death occurred in this study.Postoperatively,the cranial imaging examination showed that 24 of 34 cases were totally removed,5 cases were subtotally removed,and 5 cases were partially removed.The postoperative follow-up time was 24-48(average,36±13)months.Twenty-eight cases had good prognoses with Karnofsky score being 80 to 100,and six cases had fair prognoses with Karnofsky score being 60 to 79.Five cases had postoperative oculomotor paralysis,which was improved with nutritional nerve treatment.Conclusion The microsurgical treatment via pterional or extensive pterional craniotomy can improve the total resection rate of the large parasellar meningiomas.Palliative operations combined with postoperative radiotherapy may be employed for the tumors that can only be subtotally and partially removed.

关 键 词：脑膜瘤 显微外科术 翼点入路动眼神经麻痹 临床经验 

分 类 号：R651.1[医药卫生—外科学]