硬膜外磨除前床突在Al-Mefty分型Ⅲ型前床突脑膜瘤翼点入路手术中的应用  

Application of epidural anterior clinoid grinding in surgery through pterygoid approach for patients with Al-Mefty type Ⅲ anterior clinoid meningiomas

作　　者：王序[1] 许红旗[1] 梁洪磊 WANG Xu;XU Hong-qi;LIANG Hong-lei(Department of Neurosurgery,Anyang People's Hospital,Anyang 455000,China)

机构地区：[1]安阳市人民医院神经外科,河南455000

出　　处：《中国临床神经外科杂志》2023年第8期487-489,共3页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨硬膜外前床突旁磨除在Al-Mefty分型Ⅲ型前床突脑膜瘤(ACM)翼点入路手术中应用价值。方法回顾性分析2011年12月至2021年3月经翼点入路显微手术治疗21例Al-Mefty分型Ⅲ型ACM的临床资料。15例术中在硬膜外磨除前床突,6例未磨除前床突。结果磨除前床突的15例中,10例(66.7%)肿瘤全切除,3例大部分切除,2例部分切除;12例(80.0%)术后视力改善,3例无明显变化。未磨除前床突的6例中,2例(33.3%)肿瘤全切除,1例大部分切除,3例部分切除;2例(33.3%)术后视力改善,4例无明显变化。磨除前床突病人肿瘤全切除率和术后视力改善率较未磨除前床突病人明显提高(P<0.05)。术后新发暂时性动眼神经麻痹1例、癫痫发作1例、脑脊液漏1例。21例术后随访6~97个月,平均(37.4±13.8)个月;2例肿瘤部分切除病人出现肿瘤进展;随访期间无死亡病例。结论Al-Mefty分型Ⅲ型ACM与颈内动脉及其分支、视神经、海绵窦等重要神经血管结构的解剖关系紧密,手术难度大。术中硬膜外磨除前床突可增加手术空间,早期控制视神经和ICA,有助于提高肿瘤全切除率和视神经改善率。Objective To investigate the application value of epidural anterior clinoid grinding in surgery through pterygoid approach for patients with Al-Mefty type Ⅲ anterior clinoid meningioma(ACM).Methods The clinical data of 21 patients with Al-Mefty type Ⅲ ACM who underwent microsurgery through pterygoid approach from December 2011 to March 2021 were retrospectively analyzed.The anterior clinoid process was removed by epidural grinding in 15 patients and not in 6.Results Of the 15 patients with epidural anterior clinoid grinding,10 patients(66.7%)had a total resection of the tumors,3 greatly partial and 2 partial;12 patients(80.0%)had visual acuity improvement and 3 did not.Of the 6 patients without grinding the anterior clinoid process,2 patients(33.3%)had a total resection of the tumors,1 greatly partial,and 3 partial;2 patients(33.3%)had visual acuity improvement and 4 did not.The rates of total tumor resection and postoperative visual improvement of patients with anterior clinoid process removal were significantly higher than those without anterior clinoid process removal(P<0.05).Temporary oculomotor nerve palsy occurred in 1 patient,seizure in 1 and cerebrospinal fluid leakage in 1 after the operation.The 21 patients were followed up for 6~97 months,with an average of(37.4±13.8)months.Tumor progression occurred in 2 patients with partial resection of the tumors.There were no deaths during the follow-up.Conclusions Al-Mefty type Ⅲ ACM has close anatomical relationship with intrenal carotid artery(ICA)and its branches,optic nerve,cavernous sinus and other important neurovascular structures,and is difficult to totally resect.Intraoperative epidural grinding of anterior bed process can increase surgical space,control optic nerve and ICA in early stage,and help to improve the total tumor resection rate and optic nerve improvement rate.

关 键 词：前床突脑膜瘤 Al-Mefty分型Ⅲ型 翼点入路 显微手术 硬膜外前床突旁磨除 疗效 

分 类 号：R739.41[医药卫生—肿瘤] R651.11[医药卫生—临床医学]