中颅窝底脑膜瘤的临床特点及手术治疗研究  

Clinical characteristics and microsurgical outcomes of‘middle fossa floor’meningioma

作　　者：李三中 王凯 孙季冬 林伟 高大宽 蒋晓帆 费舟 LI San-zhong;WANG Kai;SUN Ji-dong(Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China)

机构地区：[1]空军军医大学第一附属医院神经外科,西安710032

出　　处：《临床神经外科杂志》2020年第3期273-277,共5页Journal of Clinical Neurosurgery

基　　金：国家自然科学基金(81502145)。

摘　　要：目的探讨中颅窝底脑膜瘤的临床特点、手术治疗方法,以及肿瘤切除程度与疗效之间的关系。方法回顾性分析空军军医大学第一附属医院神经外科2016年3月—2019年3月收治的24例中颅窝底脑膜瘤患者的临床资料。患者均行显微镜下肿瘤切除术,取额颞开颅,根据肿瘤暴露的需要进行断颧弓或改良眶颧入路。肿瘤切除程度根据Simpson分级判断。结果本组患者临床表现为头痛者15例、三叉神经功能障碍11例、步态障碍4例、癫痫发作4例。其中达到SimpsonⅠ/Ⅱ级切除者18例,SimpsonⅢ级切除者5例,SimpsonⅣ级切除者1例;无手术死亡患者。术后随访平均2年,2例患者肿瘤复发;其中1例患者为SimpsonⅣ级切除,复发后再次行手术治疗;另1例患者为SimpsonⅢ级切除,病理诊断WHOⅡ级(不典型脑膜瘤,Ki-67指数15%),再次手术治疗后给予适形分割放疗。结论中颅窝底脑膜瘤手术的入路,在额颞入路的基础上进行断颧弓或改良眶颧入路的个体化设计;尽量行SimpsonⅠ/Ⅱ级切除。对不能达到SimpsonⅠ/Ⅱ切除、非典型或间变性脑膜瘤患者,可早期行适形分割放疗,以防肿瘤复发。Objective To study clinical characteristics,highlights of microsurgery and relationship between the degree of tumor resection and the curative effect in patients presenting with meningiomas arising from floor of the middle cranial fossa.Methods The clinical data of 24 patients were diagnosed as meningioma arising from the base of middle cranial fossa in department of Neurosurgery,the First Affiliated Hospital of Air Force Military Medical University from 2016 and 2019 were analyzed respectively.All patients underwent microsurgery through frontotemporal approach,zygomatic arch cut off or orbital zygomatic approach modified were performed according to the needs of tumor exposure.The degree of tumor resection was judged according to Simpson's classification.Results The clinical manifestations of this group were headache in 15 cases,trigeminal nerve dysfunction in 11 cases,gait disturbance in 4 cases and epilepsy in 4 cases.Among the 24 patients,18 patients accepted Simpson gradeⅠtoⅡresection,5 patients accepted Simpson gradeⅢresection,1 patients accepted Simpson gradeⅣresection,and no surgical morbidity happened.2 median years'follow-up indicated 2 clinical recurrences.One patient received SimpsonⅣgrade resection and was operated again after recurrence.The other patient received SimpsonⅢgrade resection,the pathological diagnosis was atypical meningioma(WHO gradeⅡ,Ki-67 index 15%)and was treated with conformal fractionated radiotherapy after surgical resection again.Conclusions On the basis of frontotemporal approach,zygomatic arch cut off or orbital zygomatic approach modified are performed according to the needs of tumor exposure.For patients who can't be resected to the extent of SimpsonⅠtoⅡ,or those diagnosed as atypical or anaplastic meningiomas pathologically,conformal fractionated radiotherapy can be performed early to prevent tumor recurrence.

关 键 词：中颅窝底 脑膜瘤 Simpson分级 外科手术 额颞入路 颅底重建 

分 类 号：R739.41[医药卫生—肿瘤]