显微外科手术治疗颅内脑膜瘤疗效分析  

Microsurgery on Intracranial Meningioma(31 Cases Report)

作　　者：杨铁牛 李佳 杨金亮 王少华 YANG Tie-niu;LI Jia;YANG Jin-liang;WANG Shao-hua(Department of Neurosurgery, Fuyang Hospital of Anhui Medical University, Fuyang 236000, Anhui, China)

机构地区：[1]安徽医科大学附属阜阳医院神经外科,安徽阜阳236000

出　　处：《中国现代手术学杂志》2020年第2期122-126,共5页Chinese Journal of Modern Operative Surgery

基　　金：安徽省自然科学基金项目(1908085MH284)。

摘　　要：目的分析颅内脑膜瘤显微外科治疗效果并总结手术治疗经验。方法回顾性分析2017年7月~2020年1月我科采用显微外科手术治疗的31例脑膜瘤患者的临床资料,其中嗅沟脑膜瘤3例,窦镰旁脑膜瘤8例,蝶骨嵴脑膜瘤5例,脑室内脑膜瘤3例,大脑凸面脑膜瘤10例,后颅凹脑膜瘤2例;肿瘤直径平均3.5(2~6)cm。结果本组31例手术切除程度分级:SimpsonⅠ级18例(58.06%),SimpsonⅡ级8例(25.81%),SimpsonⅢ级3例(9.68%),SimpsonⅣ/Ⅴ级2例(6.45%);术后功能状态Karnofsky(KPS)评分:100分23例,90分5例,80分2例,70分1例。术后颅内感染4例,予抗生素联合腰大池脑脊液持续外引流,皆治愈出院,未遗留严重并发症。术后一过性视力下降1例,予以改善循环营养神经药物应用后症状消失。29例随访2月~2年,均未见复发。结论术前详细的影像学检查,术中妥善处理受累血管,保护好重要的引流静脉和功能区脑组织是提高颅内脑膜瘤显微外科手术治疗效果、减少并发症的关键。Objective To summarized the therapeutic effect and experience of microsurgical treatment on intracranial meningioma.Methods The clinical data of 31 meningioma cases treated by neurosurgical microsurgery from July 2017 to January 2020 in our hospital were retrospectively analyzed,including of 3 of olfactory groove meningioma,8 of parasagittal and parafalx meningioma,5 of sphenoid ridge meningioma,3 of intraventricular meningioma,10 of cerebral convexity meningioma and 2 of posterior fossa meningioma.The diameter of tumor sized from 2 to 6 cm with an average of 3.5 cm.Results According to the standard of Simpson resection for meningiomas,SimpsonⅠresection was achieved in 18 cases(58.06%),SimpsonⅡresection in 8 cases(25.81%),SimpsonⅢresection in 3 cases(9.68%)and SimpsonⅣ/Ⅴresection in 2 cases(6.45%).Karnofsky scored 100 points in 23 cases,90 points in 5cases,80 points in 2 cases and 70 points in 1 case.Postoperative intracranial infection was found in 4 patients,and cured by antibiotics combined with lumbar cisterna continuous drainage.Transient visual acuity decrease occurred in one case after the surgery,and the symptoms disappeared after the application of circulatory nutrition drugs.29 cases were followed up for 2 months to 2 years and no recurrence was found.Conclusion It is the key to improve the effect and induce the complication of microsurgery for intracranial meningioma by the measures of detailed imaging examination before the surgery,properly handling the involved vessels and protection of important drainage veins and functional areas during the operation.

关 键 词：脑膜瘤 显微外科手术 神经保护 

分 类 号：R739.45[医药卫生—肿瘤]