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背景与目的:目前对嗅沟脑膜瘤的治疗方法已较成熟,但对大型肿瘤患者的手术处理仍存在一定难度。本文拟探讨手术治疗大型嗅沟脑膜瘤的操作技术与经验。方法:回顾性总结2000年1月至2009年1月间在本科经手术治疗的18例大型(肿瘤最大径>5cm)嗅沟脑膜瘤患者的临床资料并进行分析。所有患者术前常规行头颅X线平片、CT及MRI检查,有10例患者同时进行了肿瘤CT血管成像扫描检查,4例患者行DSA检查。全部患者均行手术治疗,采用双额骨瓣开颅,矢状窦前部结扎经前纵裂入路,8例患者术中行腰池置管,术中使用双频射频器行肿瘤内分块切除,同时辅以神经导航系统帮助术者动态了解操作部位与肿瘤周边重要组织结构的位置关系。结果:18例患者中手术切除肿瘤达到SimpsonⅠ级10例,Ⅱ级8例。无死亡及新的神经功能缺损发生,1例术后发生脑脊液鼻漏,2例发生明显皮下积液,其中1例继发硬膜外感染,3例经处理后均治愈。14例得到1～8年随访,1例在随访期间MRI显示肿瘤有复发而行放射治疗,其余患者均未见肿瘤复发。结论:双额骨瓣前纵裂入路仍是治疗大型嗅沟脑膜瘤理想的手术入路。术前行肿瘤CT血管成像检查以及术中辅以神经导航技术对重要的血管神经及脑组织的保护具有良好的帮助作用。
BACKGROUND & OBJECTIVE: At present, the treatment of olfactory groove meningiomas has been relatively mature, but there is still some difficulty in surgical treatment of large tumors. This article intends to explore the surgical treatment of large olfactory groove meningioma operation techniques and experience. Methods: The clinical data of 18 patients with large olfactory groove meningioma who underwent surgery in our department from January 2000 to January 2009 were reviewed retrospectively. All patients underwent preoperative routine skull X-ray, CT and MRI examinations. Ten patients underwent simultaneous CT angiography and four patients underwent DSA. All patients underwent surgery, using double-bones craniotomy, sagittal sinus anterior ligation of the anterior longitudinal splitting approach, 8 patients underwent surgery in the lumbar catheterization, intraoperative use of dual-frequency radio frequency in the tumor sub-block Excision, supplemented by neuro-navigation system to help patients dynamic understanding of the operation site and the tumor surrounding the important organizational structure of the positional relationship. Results: Among the 18 patients, 10 were Simpson grade I and 8 were grade II. No death and new neurological deficit occurred. One patient had cerebrospinal fluid rhinorrhea after operation, and two patients had obvious subcutaneous effusion. One patient had secondary epidural infection and three patients were cured after treatment. Fourteen cases were followed up for one to eight years. One case showed recurrence of tumor and radiation therapy during the follow-up period. No recurrence was observed in the rest of cases. Conclusion: The approach of anterior longitudinal splitting of the bifrontal bone is still an ideal surgical approach for the treatment of large olfactory groove meningiomas. Preoperative tumor CT angiography and intraoperative imaging assisted with nerve navigation technology for the protection of important vascular nerves and brain tissue has a good help.