小脑幕脑膜瘤显微手术治疗  

Microsurgical treatment of tentorial meningioma

作　　者：罗冬冬 彭彪 罗爱萍 赵海林 李丹 胡骕 Luo Dongdong;Peng Biao;Luo Aiping;Zhao Hailin;Li Dan;Hu Su(Department of Neurosurgery,Affiliated Cancer Hospital&Institute of Guangzhou Medical University,Guangzhou,Guangdong 510095,China;Department of Hepatobiliary Surgery,Affiliated Cancer Hospital&Institute of Guangzhou Medical University,Guangzhou,Guangdong 510095,China)

机构地区：[1]广州医科大学附属肿瘤医院神经外科,510095 [2]广州医科大学附属肿瘤医院肝胆外科,510095

出　　处：《中国微侵袭神经外科杂志》2020年第10期441-444,共4页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：广州市科学创新委员会项目(编号:201707010380)。

摘　　要：目的探讨不同分型小脑幕脑膜瘤手术入路和显微手术的治疗策略。方法回顾性分析36例小脑幕脑膜瘤病例资料,根据肿瘤基底附着于小脑幕的位置及肿瘤主体部位所在而分为6个类型:幕上内侧型6例,幕上外侧型8例,幕下内侧型7例,幕下外侧型4例,跨幕型6例和镰幕型5例,采取个体化手术入路进行显微手术切除。结果小脑幕脑膜瘤达到SimpsonⅠ级切除18例(50.0%),Ⅱ级切除13例(36.1%),Ⅳ级切除5例(13.9%),无手术死亡病例。术后随访6~96个月,失访2例。术前KPS为(85.83±8.74),术后1个月为(65.83±10.52),术后6个月为(83.06±11.42)。5例肿瘤残留病人与2例复发病人,均采用伽玛刀治疗,随访中未见再次复发。结论根据小脑幕脑膜瘤不同分型,个体化选择手术入路并运用显微操作技术,可提高手术全切率,减少并发症,提高手术疗效。Objective To explore the surgical approach and microsurgical treatment strategies of tentorial meningiomas of different types.Methods The clinical data of 36 patients with tentorial meningioma were analyzed retrospectively.According to the location of the tumor base attaching to the tentorium and the main site of the tumor,tentorial meningiomas were divided into 6 types:supratentorial medial type in 6 cases,supratentorial lateral type in 8,subtentorial medial in 7,subtentorial lateral type in 4,cross-tentorial type in 6,and low-tentorial type in 5.The individualized surgical approach was adopted for microsurgical resection.Results Tentorial meningioma had a Simpson grade Ⅰ resection in 18 cases(50.0%),grade Ⅱ resection in 13(36.1%),and grade Ⅳ resection in 5(13.9%).There were no surgical deaths.The follow-up period was 6 to 96 months,and 2 cases were lost to follow-up.Preoperative KPS score was(85.83±8.74)points,65.83±10.52 at 1 month after surgery,and 83.06±11.42 at 6 months after surgery.Five patients with residual tumor and 2 patients with recurrence were treated with gamma knife,and no recurrence was observed during follow-up.Conclusions According to the different types of tentorial meningioma,individualized selection of surgical approach and the use of micromanipulation techniques can increase the total tumor resection rate,reduce complications,and improve surgical efficacy.

关 键 词：脑膜瘤 小脑幕 手术入路 神经外科手术 

分 类 号：R739.45[医药卫生—肿瘤]