摘要
目的探讨显微手术切除大型嗅沟脑膜瘤的疗效。方法回顾性分析2015年5月至2022年5月苏州大学附属第一医院神经外科采用手术切除的大型嗅沟脑膜瘤(最大直径≥3 mm)患者的临床资料, 共38例。其中采用单侧经额下入路22例、经翼点入路13例、经眶上外侧入路3例。观察术后的疗效及并发症的发生情况。结果 38例患者中, Simpson Ⅰ级切除10例(26.3%)、Ⅱ级切除27例(71.1%)、Ⅲ级切除1例(2.6%);9例术中结扎上矢状窦。共10例(26.3%)发生手术相关并发症。其中术后6例(15.8%)脑水肿加重, 2例为术中结扎上矢状窦者(1例行去骨瓣减压术);4例发生脑血肿, 1例行二次手术清除血肿, 3例保守治疗后血肿吸收;发生颅内感染1例、脑脊液鼻漏1例, 术后嗅觉损伤加重2例、新发嗅觉损伤5例, 新发视力损伤2例、精神症状4例。38例患者术后中位随访时间为31个月(2~84个月)。术前、术后出现的嗅觉损伤症状均未好转;部分患者视力和视野, 以及精神症状改善。末次随访肿瘤均无复发, Karnofsky功能状态评分>80分32例, 50~80分4例, <50分2例。结论显微手术切除嗅沟脑膜瘤肿瘤全切除率高, 严重并发症的发生率较低;术中结扎上矢状窦引发严重脑水肿的风险高。
Objective To investigate the efficacy of microsurgical resection of large olfactory groove meningiomas.Methods We retrospectively reviewed the clinical data of 38 patients with large olfactory groove meningioma(≥3 mm)who underwent surgical resection in the Department of Neurosurgery,the First Affiliated Hospital of Soochow University from May 2015 to May 2022.In this series,22 cases were treated via the unilateral subfrontal approach,13 cases via the pterional approach,and 3 cases via the lateral supraorbital approach.The postoperative efficacy and the occurrence of complications were observed.Results Among the 38 patients,10 cases(26.3%)achieved Simpson gradeⅠresection,27 cases(71.1%)achieved gradeⅡresection,and 1 case(2.6%)achieved gradeⅢresection;9 cases underwent ligation of the superior sagittal sinus.A total of 10 patients(26.3%)developed surgery-related complications.Among them,6 cases(15.8%)had aggravated cerebral edema after operation,2 cases had the superior sagittal sinus ligated during operation(1 case underwent decompressive craniectomy);4 cases developed cerebral hematoma,and 1 case underwent secondary operation to remove the hematoma,3 cases showed hematoma absorption after conservative treatment;there were 1 case of intracranial infection,1 case of cerebrospinal fluid rhinorrhea,2 cases of postoperative aggravation of olfactory damage,5 cases of newly-developed olfactory damage,2 cases of new visual impairment and 4 cases of mental symptoms.The median follow-up time of 38 patients was 31 months(2-84 months).Neither the symptoms of olfactory impairment before surgery or that developed after surgery improved;some patients′vision,visual field,and mental symptoms improved.There was no tumor recurrence at the last follow-up.The Karnofsky performance scale(KPS)was>80 in 32 cases,50-80 in 4 cases,and<50 in 2 cases.Conclusions Microsurgical resection of olfactory groove meningiomas via unilateral approach has a high tumor resection rate and a low incidence of serious complications.Intraoperative
作者
王紫兰
仇尤佳
荣孝慈
顾枫
陈周青
马超
尤万春
周鹏
朱昀
王中
Wang Zilan;Qiu Youjia;Rong Xiaoci;Gu Feng;Chen Zhouqing;Ma Chao;You Wanchun;Zhou Peng;Zhu Yun;Wang Zhong(Department of Neurosurgery,the First Affiliated Hospital of Soochow University,Suzhou 215006,China;Department of Neurosurgery,Dushuhu Affiliated Hospital of Soochow University,Suzhou 215125,China)
出处
《中华神经外科杂志》
CSCD
北大核心
2022年第10期1013-1017,共5页
Chinese Journal of Neurosurgery
基金
苏州市第五批姑苏卫生人才培养项目(GSWS2019002)。
关键词
脑膜瘤
显微外科手术
治疗结果
嗅沟
Meningioma
Microsurgery
Treatment outcome
Olfactory groove
