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目的探讨内侧型蝶骨嵴脑膜瘤的显微手术方法及技巧。方法回顾性分析2005年1月-2010年1月收治的内侧型蝶骨嵴脑膜瘤患者29例,男13例,女16例,年龄18～68岁,平均42岁,病程5个月～8年,平均28个月。采用显微神经外科手术治疗,术中对肿瘤与周围重要结构的关系进行评估,通过离断肿瘤供应血管、缩小肿瘤体积、分离肿瘤与毗邻血管及神经间隙等方法,最终彻底切除肿瘤。术后随访6个月～4年。结果肿瘤全切20例,次全切7例,部分切除2例。术前视力明显减退的20例患者,术后12例明显好转,6例无改善,2例恶化。术后2例不全偏瘫,6例动眼神经麻痹,全部患者无死亡。术后随访6个月～4年,肿瘤切除程度SimpsonⅠ、Ⅱ级者(共27例)术后未见复发,SimpsonⅢ级者(2例)切除后均行放疗或γ刀治疗,其中1例复发,再次行手术治疗。结论术中精细评估肿瘤与毗邻重要结构的关系,根据评估结果指导分离、切除肿瘤是内侧型蝶骨嵴脑膜瘤彻底切除的关键,且积极切除肿瘤对恢复视力及控制肿瘤有利。
Objective To explore the microsurgical methods and techniques of medial sphenoid ridge meningioma. Methods Retrospective analysis of 29 cases of medial sphenoid ridge meningioma admitted from January 2005 to January 2010 retrospectively, 13 males and 16 females, aged from 18 to 68 years with an average of 42 years old, with a course of 5 months to 8 Year, an average of 28 months. The use of microsurgical neurosurgery surgery, intraoperative evaluation of the relationship between the tumor and the surrounding important structure, by cutting off the supply of blood vessels, tumor volume reduction, separation of adjacent tumor and adjacent blood vessels and nerve space and other methods, the final complete removal of the tumor. Follow-up 6 months to 4 years. Totally 20 cases of tumor resection, subtotal resection in 7 cases, partial resection in 2 cases. Twenty patients with preoperative visual impairment significantly improved in 12 cases, 6 cases did not improve, and 2 cases deteriorated. Postoperative 2 cases of incomplete hemiplegia, 6 cases of oculomotor nerve paralysis, all patients without death. All cases were followed up for 6 months to 4 years. There was no recurrence of Simpson Ⅰ and Ⅱ grade (27 cases) in all cases, and Simpson Ⅲ grade (2 cases) were treated with radiotherapy or γ knife after resection, of which 1 case had recurrence Surgical treatment again. Conclusion Intraoperative fine evaluation of the relationship between the tumor and the adjacent important structures, according to the results of the assessment guide the separation and removal of the tumor is the key to complete resection of the medial sphenoid ridge meningioma, and active resection of the tumor to restore vision and control of the tumor is beneficial.