侵及上矢状窦大型和巨大型脑膜瘤的显微外科治疗  

Microsurgical treatment of large and giant parasagittal meningioma invading the superior sagittal sinus

作　　者：林国中[1] 孙建军[1] 陈素华 谢京城[1] 马长城[1] 陈晓东[1] 杨军 Lin Guozhong;Sun Jianjun;Chen Suhua;Xie Jingcheng;Ma Changcheng;Chen Xiaodong;Yang Jun(Department of Neurosurgery,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院神经外科,100191

出　　处：《中华神经外科杂志》2020年第3期243-247,共5页Chinese Journal of Neurosurgery

基　　金：首都临床特色应用研究(Z161100000516109);北京大学临床科学家计划专项(BMU2019LCKXJ007);北京大学第三医院临床重点项目(BYSY2018060)。

摘　　要：目的探讨显微外科手术切除侵及上矢状窦的大型和巨大型脑膜瘤的方法和效果。方法回顾性分析2009年5月至2019年5月北京大学第三医院神经外科收治的154例侵及上矢状窦的大型和巨大型脑膜瘤[肿瘤直径为(5.5±1.2)cm(4~8 cm)]患者的临床资料。采用翻向颞侧的"马蹄形"切口,沿中线旁和纵裂进行显微外科手术切除肿瘤。采用Simpson分级评估肿瘤的切除程度。临床随访结果以Karnofsky功能状态评分(KPS)评估,行影像学随访评估肿瘤有无复发。结果154例患者中,达到SimpsonⅠ级切除112例(72.7%),Ⅱ级切除42例(27.3%)。病理学检查均证实为脑膜瘤(世界卫生组织分级为Ⅰ级)。手术时间为30~210 min,中位时间为60 min;术后住院时间为(7.2±1.1)d(5~10 d)。术后无感染、脑脊液漏,无死亡病例,无永久性神经功能障碍加重。154例患者术后随访(63.5±0.7)个月(3~123个月),KPS为(93.6±0.3)分(80~100分);14例患者(9.1%)的肿瘤复发,其中SimpsonⅠ级切除组7例,SimpsonⅡ级切除组7例。两组复发率的差异有统计学意义(χ^2=4.01,P<0.05)。结论对于侵及上矢状窦的大型和巨大型脑膜瘤,通过显微外科手术大多可达到SimpsonⅠ级切除,有利于降低术后的复发率。Objective To investigate the method and effect of microsurgical removal of large and giant parasagittal meningioma invading the superior sagittal sinus.Methods The clinical data of 154 cases with large and giant parasagittal meningioma invading the superior sagittal sinus admitted to Department of Neurosurgery,Peking University Third Hospital from May 2009 to May 2019 were retrospectively analyzed.The diameter of the tumors ranged from 4 cm to 8 cm,with an average of 5.5±1.2 cm.Microsurgical resection was carried out along the midline and longitudinal fissure with a horse-shoe shaped skin incision turning to the temporal side.The degree of resection was evaluated by Simpson grading system.The results of clinical follow-up were evaluated by Karnofsky performance score(KPS),and the tumor recurrence was evaluated by imaging follow-up.Results Among the 154 cases,Simpson gradeⅠresection was achieved in 112(72.7%)and gradeⅡresection in 42 cases(27.3%).All of them were proved to be meningiomas(World Health Organization gradeⅠ).The operation time ranged from 30 minutes to 210 minutes(median:60 minutes),and the length of stay ranged from 5 days to 10 days with an average of 7.2±1.1 days.There was no infection,cerebrospinal fluid leakage,death or permanent aggravation of neurological dysfunction.The patients were followed up for 3 months to 123 months,with an average of 63.5±0.7 months.The KPS score ranged from 80 points to 100 points,with an average of 93.6±0.3 points.Tumor recurrence occurred in 14 patients(9.1%),including 7 in SimpsonⅠresection group and 7 in SimpsonⅡresection group.There was significant difference in recurrence rate between the 2 groups(χ^2=4.01,P<0.05).Conclusion Simpson gradeⅠmicrosurgical resection can be pursued for large and giant parasagittal meningioma invading the superior sagittal sinus which helps minimize the recurrence rate.

关 键 词：脑膜瘤 显微外科手术 治疗结果 矢状窦 大型和巨大型 

分 类 号：R73[医药卫生—肿瘤]