硬膜外磨除前床突切除前床突脑膜瘤的疗效分析  

Clinical efficacy of resection of anterior clinoidal meningiomas and extradural anterior clinoidectomy

作　　者：邬迎喜 赵天智 屈延 Wu Yingxi;Zhao Tianzhi;Qu Yan(Department of Neurosurgery,the Second Affiliated Hospital of Air Force Medical University,Xi'an 710038,China)

机构地区：[1]空军军医大学第二附属医院神经外科,西安710038

出　　处：《中华神经外科杂志》2025年第1期6-11,共6页Chinese Journal of Neurosurgery

基　　金：空军军医大学人才扶持“凌云工程”(2019axjh)。

摘　　要：目的探讨硬膜外磨除前床突切除前床突脑膜瘤的安全性及有效性。方法回顾性收集2019年1月至2023年11月空军军医大学第二附属医院神经外科接受硬膜外磨除前床突切除前床突脑膜瘤患者的临床资料,共30例。术前肿瘤Al-Mefty分型Ⅰ型7例,Ⅱ型17例,Ⅲ型6例。术后3、6个月及1年通过门诊复查对患者进行临床随访。采用头颅MRI评估患者肿瘤切除程度及术后是否复发;通过眼科门诊复查评估视力情况,并比较不同Al-Mefty分型患者术后视力改善的差异。结果30例患者的手术均顺利完成,术中均无神经血管损伤情况发生。肿瘤全切除26例(86.7%,其中Al-Mefty分型Ⅰ型5例,Ⅱ型15例,Ⅲ型6例),次全切除4例(13.3%,其中Al-Mefty分型Ⅰ型2例,Ⅱ型2例)。术后病理学证实,世界卫生组织(WHO)中枢神经系统肿瘤分级1级28例,2级(非典型)2例。术后5例(16.7%)患者发生并发症,其中出现术区少量渗血1例,癫痫发作1例,动眼神经麻痹1例,严重脑水肿2例,均经对症治疗后好转。所有患者均无颅内感染、脑梗死及死亡。术前存在视力下降的26例患者中,术后19例视力明显改善,5例无改变,2例恶化。4例患者[肿瘤次全切除、WHO 1级3例,肿瘤全切除、WHO 2级(非典型)1例]术后行立体定向放射外科治疗。30例患者的随访时间为(31.0±16.1)个月(4~58个月);末次随访显示,2例患者肿瘤复发,1例行二次手术切除,1例肿瘤体积增大继续随访观察。不同Al-Mefty分型患者术后视力情况的比较结果显示,Al-Mefty分型Ⅰ、Ⅱ、Ⅲ型患者术后视力明显改善分别为5、11、3例,无改变或恶化分别为2、6、3例,差异无统计学意义(P=0.769)。结论硬膜外磨除前床突切除前床突脑膜瘤的肿瘤全切除率高,并发症轻,且不同Al-Mefty分型患者的术后视力受益情况相似。Objective To explore the efficacy and safety of resection of anterior clinoidal meningiomas and epidural anterior clinoidectomy.Methods A retrospective study was conducted on the clinical data of 30 patients who underwent microsurgical resection of clinoidal meningiomas and epidural anterior clinoidectomy at the Department of Neurosurgery,the Second Affiliated Hospital of Air Force Medical University from January 2019 to November 2023.Preoperatively,the Al-Mefty classification was used,with 7 cases of typeⅠ,17 cases of typeⅡ,and 6 cases of typeⅢ.Follow-up was performed through outpatient visits at 3 months,6 months,and 1 year postoperatively.Cranial MRI was used to assess the extent of resection and tumor recurrence.The patient′s visual condition was assessed through ophthalmic clinic,and the differences in postoperative visual improvement was analyzed among patients with different Al-Mefty types.Results Microsurgical resection was successfully completed in all 30 cases with no intraoperative neurovascular injuries.Total tumor resection was achieved in 26 cases(86.7%,including 5 in Al-Mefty typeⅠ,15 in typeⅡ,and 6 in typeⅢ),and subtotal resection in 4 cases(13.3%,including 2 in Al-Mefty typeⅠand 2 in typeⅡ).Postoperative pathological confirmation revealed 28 cases of WHO central nervous system tumors grade 1 and 2 cases of grade 2(atypical).Five cases(16.7%)experienced postoperative complications,including 1 case of minor bleeding in the surgical area,1 case of epileptic seizure,1 case of oculomotor nerve palsy,and 2 cases of severe cerebral edema,all of which improved with symptomatic treatment.There were no cases of intracranial infection,cerebral infarction,or death.Among the 26 patients with preoperative vision loss,19 cases showed significant vision improvement postoperatively,5 cases remained unchanged,and 2 cases worsened.Four patients[3 cases with subtotal tumor resection and WHO grade 1;1 case with total tumor resection and WHO grade 2(atypical)]underwent postoperative stereotactic radi

关 键 词：脑膜瘤 神经外科手术 治疗结果 硬膜外 前床突磨除 

分 类 号：R73[医药卫生—肿瘤]