前床突脑膜瘤术中镰状韧带和视神经管的处理:80例分析  

Optic canal and falciform ligament manipulation in anterior clinoidal meningiomas:analysis of technical notes and surgical outcomes of 80 cases

作　　者：卜博[1] 余新光[1] 张远征[1] 姜金利[1] 李翀[1] 陈利锋[1] 张剑宁 BU Bo;YU Xin-guang;ZHANG Yuan-zheng(Department of Neurosurgery,General Hospital of PLA,Beijing 100853,China)

机构地区：[1]解放军总医院神经外科学部,北京100853

出　　处：《临床神经外科杂志》2021年第5期495-499,共5页Journal of Clinical Neurosurgery

摘　　要：目的探讨前床突脑膜瘤(ACMs)显微切除术中的技术问题和解决方案,包括视神经减压和镰状韧带切除的技术细节及效果评估。方法回顾性分析80例通过显微手术切除前床突脑膜瘤患者的临床资料。结果本组患者的肿瘤全切率为87.5%,次全切率10%,大部切除率3%。有33例患者磨除了前床突,其中尖部磨除者7例、部分磨除18例、全部磨除8例,开放视神经管后部者26例。视力改善者38例,总体视力改善率为47.5%,视力维持不变者34例,视力障碍加重者8例;3例术前已失明患者术后无改善。肿瘤严重包裹血管和累及海绵窦是不能全切的主要原因。结论手术的核心是保护视神经和颈内动脉及其主要分支。要做到视神经的肿瘤减压、韧带减压、骨性减压和血管减压,特别强调视神经管骨性减压,并切除管内肿瘤是全切肿瘤并改善视力的重要因素。残留的肿瘤予以立体定向放射外科治疗也可理想控制肿瘤。Objective To explore the solutions for microsurgical resection of anterior clinoid meningiomas(ACMs),including the technical details and effect evaluation of optic nerve decompression and falciform ligament resection.Methods The clinical data of 80 patients with ACMs were analyzed retrospectively.Results Rate of total removal was 87.5%,near-total removal10%,subtotal removal 3%.Anterior clinoid processes were removed in 33 cases.Visual acuity improvement in 38 cases,including enlargement of visual field.Visual acuity unchanged in 34 cases,aggravated in 8 cases.Another 3 cases lost vision before operation and didn’t recover after operation.The reasons of subtotal tumor removal were strictly incasement of ICA or its perforators and involvement of CS.Conclusions The core of the operation is to protect the optic nerve,internal carotid artery and its main branches.To achieve tumor decompression,ligament decompression,bone decompression and vascular decompression of the optic nerve,bone decompression of the optic canal and resection of the tumor in the canal are important factors for total resection and improvement of vision.Stereotactic radiosurgery can also control the residual tumor.

关 键 词：脑膜瘤 视神经减压术 镰状韧带 前床突磨除术 显微操作 神经外科手术 

分 类 号：R739.41[医药卫生—肿瘤]