经扩大翼点入路手术切除大型蝶骨嵴内侧型脑膜瘤的疗效分析  

Efficacy analysis of the large medial sphenoid ridge meningioma resection via extended pterional approach

作　　者：罗正祥[1] 陈永严[1] 张玉海[1] 钱春发[1] 邹元杰[1] 刘宏毅[1] 张岩松[1] Luo Zhengxiang;Chen Yongyan;Zhang Yuhai;Qian Chunfa;Zou Yuanjie;Liu Hongyi;Zhang Yansong(Department of Neurosurgery,Affiliated Brain Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学附属脑科医院神经外科,南京210029

出　　处：《中华神经外科杂志》2023年第1期14-18,共5页Chinese Journal of Neurosurgery

基　　金：南京市卫健委一般项目(YKK21117);南京青年卫生人才培养工程(QRX17085)。

摘　　要：探讨经扩大翼点入路手术切除大型蝶骨嵴内侧型脑膜瘤的疗效。方法回顾性分析2012年1月至2022年2月南京医科大学附属脑科医院神经外科经扩大翼点入路行肿瘤切除术的41例大型(直径≥4.0 cm)蝶骨嵴内侧型脑膜瘤患者的临床资料。术后24 h内复查头颅CT和MRI,采用Simpson分级评估肿瘤的切除程度。所有患者于术后3~24个月通过门诊或电话进行随访,评估Karnofsky功能状态评分(KPS)。术后3~60个月复查头颅MRI,评估肿瘤有无复发或进展。采用重复测量的方差分析比较术前、出院、末次随访时的KPS。结果41例患者中,SimpsonⅠ~Ⅲ级切除38例(92.7%),Ⅳ级3例(7.3%)。术后出现颅内血肿3例(死亡1例),急性脑梗死2例,脑水肿加重3例,颅内感染2例,神经功能障碍13例。40例患者的中位随访时间为36.5个月(3~60个月)。随访期间,患者的神经功能均恢复良好,基本恢复正常工作和生活。至末次随访,肿瘤复发2例,进展4例。40例患者术前、出院时及末次随访时的KPS呈逐渐升高趋势[分别为(78.2±8.5)分、(85.3±8.9)分、(91.4±9.6)分,F=69.46,P=0.033]。结论经扩大翼点入路手术切除大型蝶骨嵴内侧型脑膜瘤的疗效较好,并发症较少,术后生命质量改善。Objective To evaluate the efficacy of surgical resection of large medial sphenoid ridge meningioma via extended pterional approach.Methods From January 2012 to February 2022,41 patients with large(diameter≥4.0 cm)medial sphenoid crest meningiomas underwent tumor resection via the extended pterional approach at the Department of Neurosurgery,Affiliated Brain Hospital of Nanjing Medical University and their clinical data were retrospectively analyzed.Head CT and MRI were reexamined within 24 hours after operation,and the degree of tumor resection was evaluated by Simpson grading scale.All patients were followed up 3 to 24 months after operation by outpatient clinic or telephone,and Karnofsky performance status score(KPS)was evaluated.Head MRI was re-examined 3 to 60 months after operation to evaluate whether the tumor had recurrence or progression.Repeated-measures analysis of variance was used to compare KPS at preoperative time point,discharge,and final follow-up.Results Among the 41 patients,38 cases(92.7%)were resected with Simpson gradeⅠ-Ⅲ,and 3 cases(7.3%)were resected with gradeⅣ.There were 3 cases of intracranial hematoma after operation(1 case died),2 cases of acute cerebral infarction,3 cases of aggravated cerebral edema,2 cases of intracranial infection,and 13 cases of neurological dysfunction.The median follow-up time of 40 patients was 36.5 months(3-60 months).During the follow-up period,the neurological function of the patients recovered well,and they basically returned to normal work and life.At the last follow-up,there were 2 cases of tumor recurrence and 4 cases of tumor progression.The KPS of 40 patients before operation,at discharge and at the last follow-up showed a gradual upward trend(78.2±8.5 points,85.3±8.9 points,91.4±9.6 points respectively,F=69.46,P=0.033).Conclusion Surgical resection of large medial sphenoid ridge meningiomas via extended pterional approach has relatively good therapeutic effect,fewer complications and could improve the patients′quality of life post operati

关 键 词：脑膜瘤 蝶骨 显微外科手术 治疗结果 扩大翼点入路 

分 类 号：R739.45[医药卫生—肿瘤]