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目的进一步提高天幕脑膜瘤的治疗效果。方法1989～2003年经显微外科治疗天幕脑膜瘤患者53例,其中普通型天幕脑膜瘤42例(后外侧型32例、后内侧型10例);天幕游离缘脑膜瘤11例(前外侧型3例、后内侧型8例)。普通型天幕脑膜瘤经颞枕或枕部入路者9例,枕下正中入路6例,单侧枕下入路24例,幕上下联合入路3例;天幕游离缘脑膜瘤经枕-天幕入路7例,幕下小脑上入路2例,改良翼点入路2例。结果肿瘤全切除43例,次全切除7例,大部分切除3例;无一例手术死亡。手术后并发症主要有视野障碍(5例)、脑神经损害(7例)、偏瘫(3例)、癫痫发作(2例)、颅内感染(4例)以及手术区远隔部位硬膜外血肿(3例),均经对症治疗后痊愈。47例患者接受为期7个月～8年的随访,其中恢复正常生活学习者25例,改换工作11例,生活完全自理7例,部分自理4例。结论天幕脑膜瘤的临床表现多不典型,诊断主要依靠CT和MRI。显微手术是治疗该病的最佳方法。根据肿瘤的特点,选择适当的手术入路,合理地使用辅助器械以及熟练的手术技巧,可有效地提高天幕脑膜瘤的治疗效果。
Objective To further improve the therapeutic effect of meningiomas. Methods From 1989 to 2003, 53 cases of meningiomas were treated by microsurgery, including 42 common posterior meningiomas (posterior lateral type and posterior medial type), 11 cases of anterior limbal meningiomas 3 cases, posterior medial 8 cases). Common type meningioma by temporal or occipital approach in 9 cases, 6 cases under the suboccipital approach, unilateral suboccipital approach 24 cases, supratentorial combined approach 3 cases; Canopy approach in 7 cases, supratentorial cerebellar approach in 2 cases, improved pterional approach in 2 cases. Results Total resection of the tumor in 43 cases, subtotal resection in 7 cases, the majority of resection in 3 cases; no case of surgical death. Postoperative complications mainly include visual field disorders (5 cases), cranial nerve damage (7 cases), hemiparesis (3 cases), seizures (2 cases), intracranial infection (4 cases) Hematoma (3 cases) were cured after symptomatic treatment. Forty-seven patients were followed up for 7 months to 8 years. Among them, 25 were returned to normal life students, 11 were changed jobs, 7 were completely self-employed and 4 were partially self-employed. Conclusion The clinical manifestations of Aneurysm are mostly atypical, and the diagnosis mainly depends on CT and MRI. Microsurgery is the best way to treat the disease. According to the characteristics of the tumor, select the appropriate surgical approach, the rational use of auxiliary equipment and skilled surgical techniques, can effectively improve the therapeutic effect of meningioma sky.