蝶骨翼脑膜瘤81例临床回顾分析.doc

1 蝶骨翼脑膜瘤 81 例临床回顾分析【摘要】目的总结蝶骨翼脑膜瘤的诊断、分型及手术治疗的经验和体会。方法回顾性分析了经显微手术和病理证实的蝶骨翼脑膜瘤 81例, 其中内侧型 43例, 外侧型 36 例,扁平型 2 例。巨大型 7 例,大型 63 例,小型 11例。采用改良翼点入路 53 例;额下翼点联合入路 7 例;经颧弓翼点入路 15例; 额颞眶颧入路 6例。结果 Simpson Ⅰ级切除 45 例, Ⅱ级切除 17 例, Ⅲa 级切除 9 例, Ⅲb级6例,Ⅳ a级3 例。术后本组患者颅高压、视力下降及眼球突出等临床症状均有不同程度的改善和恢复。术后随访 9 个月~ 6年, 复发 5 例, 3 例行二次手术。结论充分全面的术前评估,正确选择手术入路,熟练掌握术区显微解剖及显微手术操作, 可以提高肿瘤全切率, 减少术后并发症, 以降低术后致残率和复发率。【关键词】蝶骨翼脑膜瘤;显微手术;回顾分析 A clinical analysis of 81 cases of meningioma 【 Abstract 】 Objective To summarize the experience and understanding of sphenoid wing meningioma diagnosis,subtype 2 and surgical treatment. Methods Total 81 cases of sphenoid ridge meningiomas, which had already been proved by microsurgical operation and post-operative pathology including inside type 43 cases,outside type 36 cases,flat type 2 cases,were retrospectively analyzed.(Huge size 7 cases,Large size 63 cases,Small size 11 cases). The operative approach included revised pterional approach 53 bined subfrontal-pterional approach 7 cases,perional approach with zygomatic arch removal 15 cases,pterional approach together with frontal and temporal approach 6 Simpson grade Ⅰ remove was 45 cases;grade Ⅱ 12 cases; Ⅲa9 cases; Ⅲb6 cases; Ⅳa3 cases. All symptoms of these group patients had relieved high intra-cranial pressure, vision deterioration and exophthalmos. Post operative follow-up from 9 months to6 years,5 cases had tumor recurrence and 3 case accepted second Thorough preoperative evaluation,adequate operative approach,full understanding of microanatomy as well as microsurgical skill can improve the rate of total resection,plications as well as post operative mortalities and morbidities. 【 Key words 】 meningioma;microsurgical 3 operation;retrospective analyze 蝶骨翼脑膜瘤占颅内脑膜瘤的 12% ~ 23% , Cushin g 将其分为内、中、外 1/3 型,近来多数学者主张分为外侧型(中、外 1/3 )、内侧型( 床突型) 和扁平型[1]。发病率内侧型多于外侧型, 内侧型约占 60% , 女性多于男性。我院自 1999 年 10 月~ 2005 年 12 月显微神经外科手术治疗蝶骨嵴脑膜瘤 81 例,效果良好,现将手术方法及体会介绍如下。 1 资料与方法 一般资料本组患者 81例, 其中男 29例