额底侧方入路切除鞍结节脑膜瘤的疗效观察及治疗体会  

Therapeutic effect and treatment experience of resection of tuberculum sellar meningiomas via lateral frontal basal approach

作　　者：李峤[1] 牛亮[1] 代军强[1] 董强 梁文涛[1] 袁国强[1] 段磊[1] 潘亚文[1] Li Qiao;Niu Liang;Dai Junqiang;Dong Qiang;Liang Wentao;Yuan Guoqiang;Duan Lei;Pan Yawen(Department of Neurosurgery,the Second Hospital of Lanzhou University,Lanzhou 730030,China)

机构地区：[1]兰州大学第二医院神经外科,兰州730030

出　　处：《中华神经外科杂志》2023年第8期777-781,共5页Chinese Journal of Neurosurgery

基　　金：甘肃省自然科学基金(20JR0RA741)。

摘　　要：目的探讨额底侧方入路切除鞍结节脑膜瘤的治疗效果及体会。方法回顾性分析兰州大学第二医院神经外科2015年12月至2021年11月采用额底侧方入路手术治疗的41例鞍结节脑膜瘤患者的临床资料,包括经眶上外侧入路手术14例,经额外侧入路手术27例。对于小型偏侧生长的肿瘤,经对侧入路手术。采用Simpson分级评估肿瘤切除程度。术后1周评估患者的视力、视野。出院后3个月及以后每年复查头颅MRI判断肿瘤有无复发。结果39例术前有视力障碍的患者中,31例术中仅切开镰状韧带即可切除视神经管内残余肿瘤,2例需磨除视神经管上壁骨质,1例需进行前床突磨除,5例仅切开镰状韧带进行视神经减压。41例患者中,肿瘤全切除39例(Simpson分级Ⅰ级10例,Ⅱ级29例),部分切除(Simpson分级Ⅳ级)2例。术前视敏度和(或)视野异常的39例患者(63只眼)中,术后31例(50只眼)改善,5例(8只眼)无变化,3例(5只眼)恶化。27例经额外侧入路手术的患者中,1例术中颈内动脉破裂,术后出现尾状核和下丘脑部分梗死;1例术后发生颅内感染。14例经眶上外侧入路手术的患者中,1例术后鞍区渗血致梗阻性脑积水;2例患者术后出现短暂性意识障碍;1例术后发生颅内感染。41例患者的随访时间为(18±5)个月(2~73)个月。至末次随访,复发3例。结论采用额底侧方入路切除鞍结节脑膜瘤的肿瘤全切除率较高,多数患者术中仅通过切开镰状韧带即可切除视神经管内残余肿瘤,手术安全性较好,患者术后视力、视野的总体改善率较高。ObjectiveTTo investigate the therapeutic effect and treatment experience of resection of tuberculum sellar meningiomas(TSMs)through lateral frontal basal approach.Methods A retrospective analysis was performed on the clinical data of 41 patients with TSM treated via the lateral frontal basal approach from December 2015 to November 2021 in the Department of Neurosurgery of the Second Hospital of Lanzhou University.Among them,lateral supraorbital approach was chosen in 14 cases and frontolateral approach in 27.For small laterally spreading tumors,a contralateral approach was used.Simpson grading was used to evaluate the degree of tumor resection.The visual acuity and visual field of the patients were evaluated 1 week after operation.At 3 months after discharge and every year thereafter,head MRI was reexamined to judge whether there was tumor recurrence.ResultsAmong 39patientswith visual dysfunction,31 cases underwent excision of falciform ligament for resection of residual tumor in the optic nerve canal,2 cases underwent deroofing of the upper wall of optic canal,1 case underwent anterior clinoidectomy,and 5 cases underwent excision of falciform ligament only for decompression of optic nerve.Among the 41 patients,39 cases achieved total resection(Simpson grade Ⅰ in 10 cases and grade Ⅱ in 29 cases)and 2 cases achieved partial resection(Simpson grade Ⅳ in 2 cases).Of 39 patients(63 eyes)with abnormal visual acuity and/or visual field before surgery,31 patients(50 eyes)improved,5 patients(8 eyes)remained stable,and 3 patients(5 eyes)deteriorated.Among the 27 patients undergoing surgery via frontolateral approach,1 patient developed intraoperative rupture of internal carotid artery and partial infarction of caudate nucleus and hypothalamus.Intracranial infection occurred in 1 case post operation.Among 14 patients undergoing surgery via lateral supraorbital approach,1 patient suffered from obstructive hydrocephalus caused by sellar region errhysis.Two patients developed transient impaired consciousness post opera

关 键 词：脑膜瘤 蝶鞍 显微外科手术 治疗结果 客额底侧方入路 

分 类 号：R739.45[医药卫生—肿瘤]