天幕脑膜瘤的影像学分型及显微手术治疗  

Imaging classification and microsurgical treatment of tentorial meningiomas

作　　者：安学锋 胡军民 秦海林 秦汉 AN Xue-feng;HU Jun-min;QIN Hai-lin;QIN Han(Department of Neurosurgery,General Hospital,Central Theater Command,PLA,Wuhan 430070,China)

机构地区：[1]中国人民解放军中部战区总医院神经外科,武汉430070

出　　处：《中国临床神经外科杂志》2021年第8期577-580,共4页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨天幕脑膜瘤的影像学分型及手术效果。方法回顾性分析2018年1月至2019年12月显微手术治疗的31例天幕脑膜瘤的临床资料。按影像学资料分型:前内侧型(Ⅰ型)、前外侧型(Ⅱ型)、内中型(Ⅲ型)、后内侧型(Ⅳ型)、后外侧型(Ⅴ型);根据肿瘤生长方向分为幕上型、幕下型、幕上下型。依据肿瘤分型选择合适手术入路。结果31例中,Ⅰ型3例,Ⅱ型5例,Ⅲ型3例,Ⅳ型8例,Ⅴ型12例;幕上型6例,幕下型19例,幕上下型6例;Simpson分级Ⅰ级切除23例,Ⅱ级5例,Ⅳ级3例。无手术死亡病例。31例术后随访3~18个月;2例部分切除术后行伽玛刀治疗,复查MRI未见肿瘤增长;1例部分切除术后13个月复查MRI显示肿瘤进展,但无新发症状,动态复查MRI随访观察;所有病人术后均恢复良好,KPS评分≥70分。结论天幕脑膜瘤手术入路的选择必须依据肿瘤的位置、大小及生长方向综合分析,个体化设计。选择合适的手术入路、熟悉掌握运用局部显微解剖关系、术中尽量避免过度牵拉造成肿瘤周围组织及血管损伤、最大程度减少手术并发症,是取得良好手术效果的关键。Objective To explore the imaging classification and microsurgical treatment of tentorial meningiomas.Methods The clinical data of 31 patients with tentorial meningioma who underwent microsurgery from January 2018 to December 2019 were analyzed retrospectively.The tumors were divided into 5 types according to the location on their images,including anterior medial type(typeⅠ),anterior lateral type(typeⅡ),inner and medium type(typeⅢ),posterior medial type(typeⅣ),and posterior lateral type(typeⅤ).The tumors were divided into 3 types according to the growth direction on their images,including upper tentorial type,lower tentorial type and upper-lower tentorial type.The surgical approach was individually chosen according the tumor imaging classification.Results Of 31 patients,3 patients were belonged to typeⅠ,5 typeⅡ,3 typeⅢ,8 typeⅣ,and 12 typeⅤ;6 upper tentorial type,19 lower tentorial type and 6 upper-lower tentorial type.Simpson gradeⅠwas achieved in 23 patients,gradeⅡin 5,and gradeⅣin 3.There were no deaths after the surgery.The follow-up of 31 patients ranged from 3 moths to 18 months.The MRI showed no growth of tumors in 2 patients with Simpson gradeⅣresecton after the gamma knife treatment,and tumor progression in 1 patient with Simpson gradeⅣresecton 13 months after the surgery.All the patients were recovered well with KPS score≥70.Conclusions The surgical approach of tentorial meningiomas should be individually chosen based on the tumor location,tumor size and tumor growth direction.Choosing an appropriate surgical approach,being familiar with the relationship between local microanatomy,avoiding excessive traction to the tissues and blood vessels surrounding the tumor during the operation,and minimizing surgical complications are the keys to achieving good surgical outcomes.

关 键 词：天幕脑膜瘤 影像学分型 手术入路 显微手术 疗效 

分 类 号：R739.41[医药卫生—肿瘤] R651.11[医药卫生—临床医学]