蝶骨嵴脑膜瘤手术治疗与并发症防治的探讨

发布时间：2018-08-17 13:46

【摘要】：目的：通过对SRMs（Sphenoid ridge meningiomas,蝶骨嵴脑膜瘤）患者的诊断、治疗及预后恢复情况的临床分析，总结我们在临床实践中获得的一些治疗心得，探讨手术操作技巧和预防并发症要点，以期进一步提高肿瘤全切率，减少术后并发症的发生，提高手术疗效。 方法：回顾性分析我科2008年-2014年行手术治疗的41例SRMs（Sphenoid ridge meningiomas,蝶骨嵴脑膜瘤）患者的临床病例资料，依据肿瘤在蝶骨嵴处的生长位置，可将其分为内侧型SRMs和外侧型SRMs两种类型，本组包括内侧型25例和外侧型16例。按照影像学上肿瘤直径的大小，又可将蝶骨嵴脑膜瘤分为巨大型（d7cm）、大型(d为4.5-7cm)和小型(d4.5cm)三种类型，分别为3例、28例和10例。术前病人均行CT、MRI或血管造影检查，评估病人的一般情况，提请科内讨论，通过影像学资料仔细分析蝶骨嵴脑膜瘤的生长特点，总结手术操作要点和合理预测预后情况。41例患者均采用经翼点入路或改良翼点入路的显微外科手术治疗，术后总结肿瘤切除的程度、术后并发症的出现及术后恢复情况。 结果：我们对所有患者按照Simpson分级法评估术后肿瘤切除的程度，Simpson I级切除19例，Simpson II级切除15例，Simpson III级切除5例，SimpsonⅣ切除2例。16例外侧型蝶骨嵴脑膜瘤患者均行Simpson I、II级切除，其中14例行I级切除，2例行II级切除，术后未见明显并发症发生。25例内侧型蝶骨嵴脑膜瘤患者中，其中23例均行Simpson I、II及III级切除，1例因肿瘤与颈内动脉和视神经粘连紧密，1例侵入海绵窦并与其内动眼神经粘连较重，均行SimpsonⅣ级切除。术前30例病人出现颅内压增高，16例视力和/或视野障碍（其中2例失明），7例病侧单眼突出，7例病灶对侧肢体肌力下降或瘫痪，1例嗅觉障碍，3例出现海绵窦综合征（主要为动眼神经损伤），3例癫痫发作，术后除外2例失明和1例海绵窦综合征病人无缓解或缓解不明显，病人余症状均有不同程度的恢复；术后出现并发症有视神经损伤2例、面神经颞支损伤1例、动眼神经损伤1例、脑梗死1例和下丘脑损伤1例，均给予积极对症处置；无死亡病例。术后随访0.5年至3年，，平均随访时间为1.5年，2例复发，无死亡。 结论：在SRMs的手术治疗中，术前对临床表现及影像学资料全面详细的综合评估，制定个体化的治疗方案，选择合适的手术入路，以扎实的颅底解剖学为基础，结合术中娴熟的显微手术操作技巧，可最大程度的切除肿瘤和显著降低术后并发症的发生，对患者的预后意义重大。
[Abstract]:Objective: to analyze the diagnosis, treatment and prognosis of SRMs (Sphenoid ridge meningiomas, patients with sphenoid ridge meningioma. In order to further improve the total tumor resection rate, reduce the incidence of postoperative complications, improve the effectiveness of surgery. Methods: the clinical data of 41 cases of SRMs (Sphenoid ridge meningiomas, sphenoid ridge meningioma treated in our department from 2008 to 2014 were retrospectively analyzed. According to the location of the tumor at the sphenoid ridge, it could be classified into medial type SRMs and lateral type SRMs. There were 25 cases of medial type and 16 cases of lateral type. According to the diameter of the tumor on imaging, the sphenoid ridge meningioma can be divided into three types: giant (d7cm), large (d: 4.5-7cm) and small (d4.5cm), which are 28 cases and 10 cases, respectively. All patients were examined by CT MRI or angiography before operation. The general situation of the patients was evaluated and discussed by Kone. The growth characteristics of sphenoid ridge meningioma were carefully analyzed by imaging data. All 41 patients were treated by microsurgery via pterygoid approach or modified pterygoid approach. The degree of tumor resection, the occurrence of postoperative complications and the postoperative recovery were summarized. Results: according to the Simpson grade method, we evaluated the degree of tumor resection in all patients. All the patients were treated with Simpson II grade II resection in 19 cases with III grade 鈪

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