经对侧眉弓入路显微切除偏侧鞍结节脑膜瘤的临床观察  

Clinical observation of microsurgical removal of the hemilateral tuberculum sellae meningiomas through contralateral eyebrow arch approach

作　　者：王晓斌 汤浩 成宜军 尚寒冰[2] 马建功 徐朕 何承 吴哲褒[2] Wang Xiaobin;Tang Hao;Cheng Yijun;Shang Hanbing;Ma Jiangong;Xu Zhen;He Cheng;Wu Zhebao(Department of Neurosurgery,the First Affiliated Hospital of Henan University,Kaifeng 475000,China;Department of Neurosurgery,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200025,China)

机构地区：[1]河南大学第一附属医院神经外科,开封475000 [2]上海交通大学医学院附属瑞金医院神经外科,上海200025

出　　处：《中华医学杂志》2022年第33期2630-2633,共4页National Medical Journal of China

基　　金：国家自然科学基金(82141114);河南省高等学校重点科研项目(20B320004)。

摘　　要：探讨经对侧眉弓入路显微切除偏侧鞍结节脑膜瘤的临床可行性。收集河南大学第一附属医院和上海交通大学医学院附属瑞金医院神经外科2016年1月至2021年6月手术的34例偏侧鞍结节脑膜瘤患者临床资料,所有患者均采用经对侧眉弓入路显微手术。术后视力改善率88.5%(23/26),肿瘤全切率88.2%(30/34);肿瘤全切者术后视力改善优于部分切除者[90.9%(20/22)比3/4],视神经上侧型和视神经外上侧型者术后视力改善优于视神经外侧型者(12/14、8/8比3/4)。术后出现眶上皮肤麻木感3例,随访期间症状消失;出现轻度激素水平紊乱2例,尿量增多2例,经对症治疗恢复正常;皮下积液1例,经治疗后吸收;未出现嗅觉障碍、颅内感染等并发症。随访3~60(33±6)个月2例复发再次手术治疗。对于偏侧生长的鞍结节脑膜瘤,依据鞍结节脑膜瘤起源侧别、视力障碍侧别等术前评估,选择经肿瘤对侧眉弓入路,充分显露视神经内下方的肿瘤基底,有利于在直视下全切除肿瘤,术后视力障碍症状改善明显,可以作为一种临床经验应用。The current study aimed to investigate the clinical feasibility of microscopic resection of hemilateral tuberculum sellae meningiomas(TSM)via the contralateral eye brow arch approach.The clinical data of 34 patients with TSM who underwent microsurgery from January 2016 to June 2021 in the Neurosurgery Department of Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine and the First Affiliated Hospital of Henan University were collected and reviewed.The postoperative visual acuity improvement rate was 88.5%(23/26),and the total tumor resection rate was 88.2%(30/34);the postoperative visual acuity improvement in patients with total tumor resection was better than that of patients with partial resection[90.9%(20/22)vs 3/4].Meanwhile,the postoperative visual acuity improvement in patients with the superior optic nerve and laterl-superior optic nerve was better than that of patients with the lateral optic nerve type(12/14,8/8 vs 3/4).Supraorbital skin numbness occurred in 3 cases after operation,and the symptoms disappeared during follow-up;2 cases had mild disturbance of hormone level,and urine output of 2 cases increased after operation,which returned to normal level after symptomatic treatment;1 case had subcutaneous effusion which was absorbed after treatment.There were no complications such as olfactory disturbance and intracranial infection.During follow-up for 3-60(33±6)months,recurrence occurred in 2 cases and reoperation was performed.For the hemilateral TSM,according to the preoperative evaluation of the origin of the TSM and the side with visual impairment,the contralateral eyebrow approach is selected to fully expose the tumor base below the optic nerve.It is beneficial to fully resect the tumor under direct vision,and the symptoms of postoperative visual impairment are significantly improved,indicating that the current surgical method can be used in the clinical setting.

关 键 词：脑膜瘤 鞍结节 偏侧 对侧眉弓 显微手术 

分 类 号：R739.45[医药卫生—肿瘤]