鞍上脑膜瘤手术治疗及视神经功能保护策略  

Surgical treatment of suprasellar meningiomas and strategies to protect optic nerve function

作　　者：李军涛 步星耀[1] 马春晓[1] 孙勇[1] 李治晓[1] 闫兆月[1] 贾玉龙 高玉帅 Li Juntao;Bu Xingyao;Ma Chunxiao;Sun Yong;Li Zhixiao;Yan Zhaoyue;Jia Yulong;Gao Yushuai(Department of Neurosurgery,Henan Provincial People′s Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院神经外科,郑州450003

出　　处：《中华神经外科杂志》2022年第3期250-254,共5页Chinese Journal of Neurosurgery

基　　金：河南省科技攻关重点项目(192102310126);河南省医学科技攻关省部共建重点项目(201601016)。

摘　　要：目的探讨鞍上脑膜瘤手术治疗及视神经功能保护的临床策略。方法回顾性分析2017年1月至2020年12月河南省人民医院神经外科行手术治疗的165例鞍上脑膜瘤(直径>2 cm)患者的临床资料。手术均采用硬膜内肿瘤切除术,术中根据不同的治疗策略分别行视神经管和(或)前床突磨除(简称磨除组,81例)和未行颅底骨质磨除(简称未磨除组,84例)。术后采用Simpson分级评估肿瘤的切除程度;手术前、后行视力视野检测,以评价术后患者视力视野的变化情况。结果磨除组与未磨除组患者的基线资料比较差异均无统计学意义(均P>0.05)。165例患者中,SimpsonⅠ~Ⅲ级切除139例,SimpsonⅣ级切除26例。与未磨除组比较,磨除组的肿瘤全切除率明显升高,分别为93.8%(76/81)、75.0%(63/84)(P<0.05)。术后6个月的随访结果显示,磨除组患者的视力视野改善率明显高于未磨除组,分别为82.9%(58/70)、64.1%(41/64),且磨除组较未磨除组患者术后的视力视野恶化率更低,分别为2.5%(2/80)、12.0%(10/83)(均P<0.05)。术前影像学提示肿瘤未侵及视神经管的109例患者中,磨除组的视力视野改善率同样高于未磨除组,分别为73.5%(36/49)、53.3%(32/60)(P<0.05)。结论鞍上脑膜瘤术中行视神经管和(或)前床突磨除等措施不仅能明显改善患者术后的视力视野,而且能提高肿瘤的全切除率。Objective To explore the clinical strategies for surgical treatment of suprasellar meningiomas and protection of optic nerve function.Methods A retrospective analysis was conducted on the clinical data of 165 patients with suprasellar meningiomas(diameter>2 cm)who underwent surgical operations at Department of Neurosurgery,Henan Provincial People′s Hospital from January 2017 to December 2020.Intradural tumor resection was used in all operations.According to different intraoperative treatment strategies,the patients were divided into the removal group(n=81)which had surgical removal of the optic canal or/and anterior clinoid process and non-removal group(n=84)which had no removal of skull base.Simpson classification was used to evaluate the degree of tumor resection after operation.Visual acuity and visual field tests were performed before and after surgery to evaluate the improvement degree in both groups.Results There was no significant difference in baseline data between the removal group and the non-removal group(all P>0.05).Among the 165 patients,139 underwent Simpson gradeⅠ-Ⅲresection,and 26 underwent Simpson gradeⅣresection.Compared with the non-removal group,the removal group could significantly improve the total tumor resection rate,which was 93.8%(76/81)in removal group and 75.0%(63/84)in non-removal group(P<0.05).The 6-month follow-up showed that the visual acuity and visual field improvement rate of the patients in the removal group was significantly higher than that in the non-grinding group,which were 82.9%(58/70)and 64.1%(41/64)respectively(P<0.05).The postoperative visual acuity and visual field deterioration rate of the patients in the removal group(2.5%,2/80)was lower than that in the non-removal group(12.0%,10/83)(P<0.05).Among the 109 patients whose tumors did not invade the optic canal based on preoperative imaging,the visual acuity and visual field improvement rate in the removal group(73.5%,36/49)was also higher than that in the non-removal group(53.3%,32/60)(P<0.05).Conclusion Durin

关 键 词：脑膜瘤 蝶鞍 显微外科手术 视神经 治疗结果 

分 类 号：R739.45[医药卫生—肿瘤]