摘要
目的 探讨天幕脑膜瘤的手术入路、手术方式 ,总结治疗效果。方法 回顾性分析 37例天幕脑膜瘤患者的临床表现、影像学资料、手术入路、切除程度及 2 1例随访资料。结果 患者平均年龄 39.8岁 ,主要临床表现为头痛 (83.8% )、步态不稳 (35 .1% )和偏盲 (2 1.6 % )。根据肿瘤附着于天幕的位置分为 5型。直接手术 36例 ,11例幕上入路 ,2 5例幕下入路。肿瘤全切 (SimpsonⅠ级和Ⅱ级 ) 2 8例 (77.8% ) ,次全切除 8例 (2 2 .2 % ) ,死亡 1例。随访 2 1例 ,14例 (6 6 .7% )恢复正常生活 ,3例(14 .3% )生活不能自理。 8例次全切除者随访 4年 ,未见肿瘤的生长 ,未再次手术。结论 术前应根据肿瘤的位置及周围结构受累的情况选择合适的手术入路及切除方式 ,对天幕裂孔处的肿瘤切除困难时 ,可采取次全切除以保证患者的生存质量。
Objective To explore the surgical approach, resection way of tentorial meningiomas(TM) and summarize the effect of treatment.Methods A retrospective study was done on 37 patients with TM. The clinical presention, neuroradiological data, surgical approach, the extent of resection and follow up data of 21 cases were reviewed.Results The average age was 39.8 years. Headpain (83.3%), gait ataxia(35.1%) and hemianopia(21.6%) were the most common clinical manifestation. According to the site of tumor attachment, TM was divided into five subgroups. Direct surgery was performed in 36 cases, including 11 supratentorial and 25 infratentorial approach. Total removal(Simpson group Ⅰ and Ⅱ) in 28(77.8%) patients and subtotal removal in 8(22.2%), and one patient died. Twenty one cases were followed up, 14 cases had resumed normal life and 3 cases were not able to self care. Eight cases with subtotal removal were followed up for 4 years, no residual tumor progression and no reoperation.Conclusion Appropriate surgical approach and resection way should be selected according to the site of tumor attached to the dura and the surrounding structure involved preoperatively. Subtotal removal can be considered when it is difficult to resect in order to preserve the quality of life for tentorial edge meningiomas .
出处
《中华神经外科疾病研究杂志》
CAS
2004年第6期511-514,共4页
Chinese Journal of Neurosurgical Disease Research
关键词
脑膜瘤
天幕
分类
手术入路
Meningioma
Tentorium
Classification
Surgical approach
