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目的回顾分析经不同入路开颅显微手术治疗及病理证实26例嗅沟脑膜瘤病例,探讨嗅沟脑膜瘤的显微手术入路及疗效。方法 26例病人中,男,10例,女,16例。术前CT及MRI检查发现为前颅窝底一圆形或卵圆形占位性病变,边界清楚,增强均一强化明显。肿瘤位于中线5例;向右侧延伸9例;向左侧延伸12例;压迫大脑前动脉8例;压迫视交叉5例;骨质增生7例;肿瘤侵蚀筛窦6例;侵蚀蝶鞍3例;肿瘤周围脑水肿18例。26例病人按肿瘤大小及位置,分别经额眶开颅,翼点开颅及前纵裂开颅在显微镜下分块切除肿瘤。结果 SimpsonⅠ级切除7例,SimpsonⅡ级切除19例。术后新发嗅觉丧失5例;术后短期失明1例,经神经营养治疗21天后视力恢复,随访1年视力恢复正常;术后感染1例,经抗炎治疗恢复。本组无死亡病例。结论较小肿瘤采用经翼点及前纵裂入路,较大肿瘤采用经额眶入路,可以近距离达到肿瘤而无需切除脑组织,有利于切除肿瘤基地,阻断肿瘤血供,减少术中出血。
Objective To retrospectively analyze 26 cases of olfactory groove meningioma confirmed by craniotomy microsurgery and pathology, and to explore the microsurgical approach and efficacy of olfactory groove meningioma. Methods 26 cases of patients, male, 10 cases, female, 16 cases. Preoperative CT and MRI examination found anterior orbital floor of a circular or oval-shaped space-borne lesions, clear boundaries, enhance the uniformity and strengthen the obvious. The tumors were located in the midline in 5 cases, 9 cases were extended to the right, 12 cases were extended to the left, 8 cases were compressed to the anterior cerebral artery, 5 cases were the optic chiasm, 7 cases were bone hyperplasia, 6 cases were tumor erosive ethmoid sinus. Cases; tumor around the brain edema in 18 cases. Twenty-six patients underwent tumor resection and tumor resection under the microscope according to the tumor size and location, respectively by craniotomy, craniotomy and pterygoid craniotomy. Results Simpson Ⅰ resection in 7 cases, Simpson Ⅱ resection in 19 cases. 5 cases of new smelling loss after operation, 1 case of short-term blindness after operation, visual acuity recovery after 21 days of neurotrophic therapy, 1 year of follow-up of visual acuity returned to normal, 1 case of postoperative infection and recovery after anti-inflammatory treatment. No deaths in this group. Conclusions The smaller tumor approach via the wing point and anterior longitudinal splitting approach, larger tumors by the amount of orbital approach, can reach the tumor without the need to remove the brain tissue, is conducive to the removal of the tumor base, blocking the tumor blood supply, reduce the operation Bleeding.