双侧大脑镰旁脑膜瘤的临床分型与手术方案

发布时间：2018-03-05 23:07

  本文选题：双侧大脑镰旁脑膜瘤　切入点：分型　出处：《山东大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的： 探讨双侧大脑镰旁脑膜瘤的临床分型与手术治疗。 方法： 回顾性分析山东大学齐鲁医院自2002年1月至2012年12月期间收治的颅内脑膜瘤的患者共1503例患者,筛选出31例病例符合研究方向并经手术治疗的病例,分析其一般资料、临床表现、影像学特点、病理特点、手术情况、术后情况、治疗效果及术后随访结果,根据大脑镰两侧肿瘤的基底、对称性及基底间距离的情况等因素提出了一个双侧大脑镰旁脑膜瘤的临床分型及其手术方案。 结果： 在符合研究方向的1503例脑膜瘤患者中镰旁脑膜瘤共117例(约占脑膜瘤病例总数的7.78%),根据诊断标准,本研究共筛选出31例(约占镰旁脑膜瘤病例总数的26.5%)双侧大脑镰旁脑膜瘤符合要求,其中共有16例男性患者及15例女性患者。年龄跨度自20岁～81岁,平均年龄54.1岁。病程跨度自1周～9年,平均病程约1.9年。所有肿瘤均以大脑镰为基底向各个方向发展,向上侵犯上矢状窦的15例,向下侵犯下矢状窦或压迫胼胝体的6例,包绕胼周动脉的1例,向硬膜外发展侵犯颅骨的1例。患者常见症状是头痛、头晕共23例,恶心、呕吐共5例,一侧肢体活动受限17例,双下肢活动受限2例,肢体感觉异常3例,抽搐4例,视力下降和(或)视野缺损6例,记忆力下降3例,性格改变1例,头外伤后CT检查发现肿瘤的无症状患者1例。Simpson Ⅰ级切除23例,Simpson Ⅱ级切除4例,Simpson Ⅲ级切除4例,Simpson Ⅳ级切除0例。无手术死亡。所有患者术后均恢复良好,症状减轻或消失。随访3个月-3年,未见复发病例。 结论： 通过31例双侧大脑镰旁脑膜瘤病例的分析,根据双侧大脑镰旁脑膜瘤是否同基底、是否对称以及肿瘤间距离的大小等因素将双侧大脑镰旁脑膜瘤分为两大型4个亚型,分别为ⅠA型为两侧肿瘤同基底且对称(共6例),ⅠB型为两侧肿瘤同基底且不对称(共23例)；ⅡA型为两侧肿瘤异基底且相距较远(共1例),ⅡB型为两侧肿瘤异基底且相距较近(共1例)。并根据以上分型指导手术方式。该分型对于指导手术方案,提高手术疗效具有一定的参考价值。
[Abstract]:Objective:. To investigate the clinical classification and surgical treatment of bilateral paraspinal meningioma. Methods:. A retrospective analysis of 1503 patients with intracranial meningioma admitted from January 2002 to December 2012 in Qilu Hospital of Shandong University was made. 31 cases of intracranial meningioma were screened out, and their general data were analyzed. Clinical manifestations, imaging features, pathological features, surgical conditions, postoperative conditions, therapeutic effects and postoperative follow-up results, according to the base of bilateral tumors of sickle cerebri, A clinical classification and surgical scheme of bilateral paraspinal meningioma were proposed for symmetry and distance between bases. Results:. Of the 1503 cases of meningioma in accordance with the research direction, 117 cases (about 7.78% of the total number of meningioma cases) were paraxillar meningiomas, according to the diagnostic criteria, A total of 31 cases (about 26.5% of the total number of cases of paraspinal meningioma) were selected in this study, including 16 male patients and 15 female patients. The age ranged from 20 to 81 years old. The mean age was 54.1 years. The course of disease ranged from 1 week to 9 years, and the average duration was about 1.9 years. All tumors developed in all directions with sickle cerebri as the base, 15 cases with upward invasion of the superior sagittal sinus, and 6 cases with downward invasion of the inferior sagittal sinus or compression of the corpus callosum. The common symptoms were headache, dizziness (23 cases), nausea and vomiting (5 cases), limited movement of one limb (17 cases), and limited movement of both lower limbs (2 cases), the common symptoms were headache, dizziness (23 cases), nausea and vomiting (5 cases), limited movement of one side of extremity (17 cases) and limited movement of lower limbs (2 cases). There were 3 cases of limb sensory abnormality, 4 cases of convulsion, 6 cases of vision loss and / or visual field defect, 3 cases of memory loss, and 1 case of personality change. Ct examination after head trauma showed that 1 case of asymptomatic tumor was resected by Simpson 鈪，

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