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目的：探讨天幕脑膜瘤的分型和手术入路的选择。方法：对1996年1月～2005年4月间收治的天幕脑膜瘤进行回顾性分析,并按分型选择不同的手术入路。本组26例,其中内侧型10例；外侧型12例；镰幕型4例。对主要向幕上发展者,根据肿瘤的部位,采用扩大翼点入路、颞下入路、颞枕部入路和枕部入路；肿瘤全部或主体在颅后窝者,采用枕下或枕部一枕下联合开颅术；跨幕者采用颞下一乙状窦前入路；镰幕型均采用枕部入路。结果：本组肿瘤全切除23例,次全切除3例,全组无死亡,术后出现新增神经功能障碍2例,复发5例。结论：天幕脑膜瘤手术入路的选择必须根据患者的解剖分型进行个体化设计；熟悉局部显微解剖并熟练运用显微外科技术是取得手术成功的关键。
Objective: To explore the classification of the type of meningioma and the choice of surgical approach. Methods: A retrospective analysis was performed on ameloblastoma treated between January 1996 and April 2005, and different surgical approaches were selected according to the type. The group of 26 cases, including 10 cases of medial type; lateral type in 12 cases; 4 cases of sickle screen. On the main screen to the developers, according to the site of the tumor, the use of expanded pterional approach, infratemporal approach, temporal occipital approach and occipital approach; all or main tumor in the posterior fossa of the skull, using suboccipital or Occipital a combined suboccipital craniotomy; transvestite use of the inferior temporal sigmoid anterior approach; sickle-type are used occipital approach. Results: In this group, 23 cases were completely resected and 3 cases were subtotally resected. There was no death in the whole group. There were 2 cases of new neurological dysfunction and 5 cases of recurrence after operation. CONCLUSIONS: The choice of surgical approach to meningioma has to be individualized based on the patient’s anatomy. Being familiar with local microdissection and using microsurgical techniques is the key to successful surgery.