摘要
目的观察巨大型脑膜瘤切除术后颅内压（ICP）的变化规律，分析并探讨其变化规律的原因。方法回顾性分析苏州大学附属第一医院于2013年10月至2014年7月收治并手术治疗的7例颅内巨大型脑膜瘤患者的临床资料、手术方式、ICP监测数据。肿瘤分别位于额部（1例），嗅沟（1例），蝶骨嵴（2例），大脑镰旁（1例），矢状窦（1例），岩斜区（1例）。手术方式分别采用扩大翼点入路，额下入路，纵裂入路，颞下入路切除肿瘤。ICP监测探头置于硬脑膜下，平均监测时间约9 d。所有患者术后均常规应用20%甘露醇脱水。结果7例肿瘤均镜下全切（Simpson Ⅰ、Ⅱ级），患者术后第3天均出现ICP升高，第4天达到高峰，第5～7天逐渐回到正常水平。其中1例患者在术后第3天意识恶化，ICP持续上升，CT提示严重脑水肿，急诊行去骨瓣减压和气管切开术。所有患者恢复良好，仅有1例患者术后出现脑脊液鼻漏，保守治疗后明显改善。结论ICP监测在巨大脑膜瘤切除术后应用作用显著，根据其变化趋势，不仅可以分析术后ICP波动的原因，同时结合充分的术前检查、合理的手术入路、细致的术后管理，为患者术后脑功能的改善提供了帮助。
ObjectiveTo investigate varying patterns of intracranial pressure（ICP）after giant meningioma resection and analyze the causes of the variation of ICP in different postoperative phases.MethodsClinical data, surgical approachs and the ICP monitoring data of 7 patients with giant meningioma in different positions who were admitted to the First Affiliated Hospital of Soochow University from October 2013 to July 2014 and received microsurgical resection via different approachs were analysed retrospectively. The tumour locations were in convexity（n=1）, olfactory groove（n=1）, sphenoidal ridge（n=2）, parasagittal（n=1）, falx（n=1）, petroclival（n=1） and resected via longitudinal fissure approach, subfrontal approach, extensive pterional approach, subtemporal approach. ICP monitoring probe was placed subdurally and average monitoring time was 9 days. Dehydrating agent was administered in all cases postoperatively.ResultsTumors were totally resected （Simpson Grade Ⅰ or Ⅱ ） in all patients. The increase of ICP was observed on the 3rd day, peaked on the 4th day and reduced to normal on the 5th-7th day. Decompressive craniectomy and tracheotomy were performed in one case due to consciousness deterioration, severe brain edema and continuous ICP augment on the third day after operation. All the patients recovered well except for the cerebrospinal fluid rhinorrhea occurring in one case postoperatively, whose symptom ameliorated significantly after conservative treatment.ConclusionICP monitoring exerts an important role on the postoperative management of giant meningioma. Simultaneously, The summary of vast ICP monitoring data concerning to giant meningioma provides the evidence and experience for protecting neurological function via abundant preoperative preparations, reasonable operative approach, careful postoperative management.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2016年第24期1926-1928,共3页
National Medical Journal of China
关键词
颅内压
脑膜瘤
显微手术
Intracranial pressure
Meningioma
Microsurgery
