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目的探讨不同部位和大小的鞍结节脑膜瘤显微手术入路和手术结果。方法回顾分析安徽省立医院神经外科自2002年01月至2011年07月鞍结节脑膜瘤49例,采用5种不同的手术入路,采用显微外科技术手术切除。分析全切除率、手术效果和并发症发生的情况。结果经单侧额下入路18例,经冠状开颅额下入路15例,冠状开颅前纵裂入路7例,眶上锁孔入路5例,翼点或改良翼点入路4例。肿瘤切除程度按Simpson分级评估,达SimpsonII级切除者40例,III级切除者9例,肿瘤全切除率(Simpson II级)为81.6%。本组1例死亡病例,死亡原因考虑术前患者即肿瘤卒中昏迷,术后致多脏器衰竭。术前38例合并视力减退及视野缺损,术后视力较术前明显改善20例,无明显变化17例,视力加重1例。结论显微手术是治疗鞍结节脑膜瘤的主要手段,手术入路选择应根据:①肿瘤的生长方式,肿瘤的大小。②术前视力视野受累程度。③术者习惯。④手术路径最短,对脑组织损伤最小。手术疗效取决于:术前视力受累程度,病程的长短,术中对神经、血管和脑组织的保护,肿瘤全切除率等。
Objective To investigate the microsurgical approach and surgical results of saddle nodular meningiomas with different sites and sizes. Methods Retrospective analysis of 49 cases of saddle nodular meningiomas from January 2002 to July 2011 in Department of Neurosurgery, Anhui Provincial Hospital. Surgical removal was performed by using 5 different surgical approaches. Analysis of total resection rate, surgical results and complications occurred. Results 18 patients underwent unilateral frontal approach, the inferior cranial cranial approach in 15 cases, coronal craniofacial approach in 7 cases, 5 cases of supraorbital keyhole approach, wing point or modified pterional approach 4 cases. The extent of tumor resection was assessed by Simpson grading, 40 cases of Simpson class II resection, 9 cases of class III resection and total tumor removal rate (Simpson II grade) of 81.6%. The group of 1 deaths, the cause of death to consider preoperative patients with tumor stunned unconsciousness, multiple organ failure after surgery. Preoperative 38 cases with visual acuity and visual field defects, postoperative visual acuity was significantly improved compared with preoperative 20 cases, no significant change in 17 cases, 1 case of visual acuity. Conclusions Microsurgery is the main method for treatment of tuberculum sellae meningiomas. Surgical approach should be based on: ① the growth pattern of the tumor and the size of the tumor. ② preoperative visual acuity affected degree. ③ surgeon habits. ④ the shortest surgical path, the smallest damage to brain tissue. Surgical efficacy depends on: the degree of preoperative visual acuity, the duration of the disease, intraoperative nerve, blood vessels and brain tissue protection, tumor resection rate.