39例镰旁脑膜瘤的显微手术治疗体会(1)
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【摘要】 目的 探讨大脑镰旁脑膜瘤的显微手术治疗的方法与技巧。方法 回顾性分析2004年5月至2009年6月,39例大脑镰旁脑膜瘤的临床资料。结果 根据骑跨大脑镰的位置选择手术入路,应用显微手术切除大脑镰旁脑膜瘤39例,其中34例肿瘤Simposon I级切除,3例SimpsonⅡ级切除,1例SimpsonⅢ级切除,1例Ⅳ级。术后随访6～36个月,恢复良好,手术死亡1例,无肿瘤复发。结论 采用显微外科技术能提高骑跨大脑镰脑膜瘤的全切率,降低复发率,减少残死率;如果全切肿瘤可能带来重要的神经功能损害,应考虑分期手术或者残留部分肿瘤。手术切除程度可达SimpsonⅠ～IV级;良好的手术暴露、有效地控制术中出血、保护并妥善处理好上矢状窦和避免脑皮质损伤是提高手术疗效的关键因素。
【关键词】 矢状窦;脑膜瘤;显微外科技术
Microsurgical Treatment of Parasagittal Meningiomas
CUI Yan-kui,WANG Qing-feng,HAN Dong,et al.
Department of Neurosurgery,The second people Hospital,Jiaozuo 454000,China
【Abstract】 Objective To evaluate the technique and artifice of microsurgery treatment for parasagittal meningiomas.
Methods A retrospective analysis was performed on the clinical data of 39 cases of parasagittal meningioma between May 2004 and Jun 2009.Results According to the location straddling the falx choice surgical approach,39 cases of cerebral falx meningioma was treated by microsurgical. Simpson Grade I resection was achieved in 34(87.2%) cases,Grade Ⅱ in 3(7.7%) cases,Grade Ⅲ in 1(2.6%) cases and Grade IV in 1(2.6%) case. All patients were followed up for 6 months to 3 years. Only one patient died after the surgical operation and no patient suffered the recrudescence.Conclusion Application of microsurgical techniques can improve the saddle falx meningioma of the total removal rate,lower recurrence rate and reduce the rate of residual dead;if the whole tumor cut may bring significant neurological damage,should be considered part of staging surgery or residual tumor,and the degree of surgical resection of up to Simpson I-IV level;Good surgical exposure,effectively control the bleeding,protection and avoidance of damage to the cerebral cortex and superior sagittal sinus were important factors which increaseing the success rate of surgical resection.
【Key words】 Sagittal sinus;Meningioma; Microsurgery
脑膜瘤是最常见的颅内良性肿瘤,大脑镰旁脑膜瘤发病率占脑膜瘤发病率的11%,居脑膜瘤发病率的第3位[1]。其中骑跨大脑镰的脑膜瘤是大脑镰旁脑膜瘤中的特殊类型,系单一脑膜瘤骑跨大脑镰向两侧生长。2004 年5月至2009 年6月,本科收治大脑镰旁脑膜瘤39例,现报告如下。
1 资料与方法
1.1 一般资料 男17例,女22例;年龄21～76岁,平均36.4岁,病程2周～4.5年,且均经术后病理检查证实。肿瘤位于大脑镰前1/323例,中1/39例,后1/35例,前中、中后1/3交界处各2例。其中有不同程度的头晕、头痛31例,伴记忆力下降、反应迟钝11例,双侧肢体乏力26例,一侧下肢感觉或运动障碍18例,突发癫痫起病13例,视野缺损或视物模糊5例,大小便功能障碍1例。
1.2 辅助检查 39例均行头颅CT、MRI检查,CT显示颅内大脑镰旁类园形、扁平状或分叶状高密度影22例,等或混杂密度影 11例,低密度影3例; 均有脑受压移位的改变 ......
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