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目的:探讨显微手术切除辅助γ刀治疗鞍区大型脑膜瘤的临床效果和安全性,阐明该方法对鞍区大型脑膜瘤的临床疗效。方法:回顾性分析显微手术治疗的34例鞍区大型脑膜瘤患者的临床资料。所有患者先行显微手术切除肿瘤,有残留的部位术后1个月行γ刀治疗,分析其肿瘤切除情况、并发症、症状缓解率以及复发率。结果:肿瘤全切(SimpsonⅠ级7例,Ⅱ级12例)19例(55.9%)、次全切(SimpsonⅢ级)14例(41.2%)和大部分切除(SimpsonⅣ级)1例(2.9%);术后主要并发症有颅神经损伤(动眼、滑车和外展)6例、对侧肢体轻瘫2例、术后出血1例、脑脊液漏伴感染3例和继发性癫痫3例,无手术死亡。随访3~48个月,24例头痛消失(80%),6例减轻(20%);12例视力好转(80%),2例无明显变化(13.3%),1例加重(6.7%);5例嗅觉好转(62.5%),3例无变化(37.5%);5例眼球运动障碍恢复(71.4%),2例无变化(28.6%);7例一侧肢体无力患者术后肌力均恢复正常(100%)。全切患者中1例复发(5.2%),未全切患者均行γ刀治疗,2例复发(13.3%)。结论:显微手术辅助γ刀治疗对鞍区大型脑膜瘤治疗效果良好。
Objective: To investigate the clinical effect and safety of microsurgical excision assisted gamma knife in the treatment of large meningioma in the sellar region, and to elucidate the clinical effect of this method on the large meningioma in the sellar region. Methods: The clinical data of 34 cases of meningioma major in the sellar region were analyzed retrospectively. All patients undergone microsurgical resection of the tumor first, and the remaining sites were treated with gamma knife one month after operation, and their resection status, complications, symptom relief rate and recurrence rate were analyzed. RESULTS: Totally 19 patients (55.9%) had complete resection (Simpson grade I and 12, grade II), 14 cases (41.2%) underwent subtotal (Simpson grade III) and one case (2.9%) underwent partial resection ; 6 cases of cranial nerve injury (movement, pulley and abduction), 2 cases of contralateral limb paresis, 1 case of postoperative bleeding, 3 cases of cerebrospinal fluid leakage associated with infection and 3 cases of secondary epilepsy. No surgery died. 24 cases had headache disappeared (80%) and 6 cases reduced (20%) after 3 ~ 48 months of follow-up. 12 cases showed improvement of visual acuity (80%), 2 cases showed no significant change ; 5 cases had olfactory improvement (62.5%), 3 cases had no change (37.5%); 5 cases had ocular dyskinesia (71.4%), 2 cases had no change (28.6%); 7 cases of limb weakness All returned to normal (100%). One of the patients underwent resection (5.2%). Gamma knife treatment was performed on patients who had not undergone complete resection and two cases of recurrence (13.3%). Conclusion: Microsurgical assistant gamma knife treatment of meningioma in the saddle area has a good effect.