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目的探讨经颅入路切除蝶-眶脑膜瘤的手术方法及疗效。设计回顾性病例系列。研究对象32例蝶-眶脑膜瘤患者,其中良性脑膜瘤(WHOⅠ级)28例,其中上皮型24例,纤维型3例,砂粒体型1例;生长活跃或不典型脑膜瘤(WHOⅡ级)2例;恶性脑膜瘤(WHOⅢ级)2例。方法采用发际内额颞弧形切口,在硬脑膜外磨除增生的蝶骨大翼骨质,眶上裂、视神经管开放减压,增厚的眶骨膜连同肿瘤一并切除,用颞肌筋膜或人工脑膜修补硬脑膜及眶骨膜缺损。主要指标术前、术后突眼,眼球运动等临床表现,肿瘤的切除程度及复发率。结果肿瘤切除程度:SimpsonⅡ级8例、SimpsonⅢ级20例、SimpsonⅣ级4例。术后突眼情况均有好转,6例患者术后外展受限,4例上睑下垂。随访有6例患者肿瘤复发。结论经颅入路切除蝶-眶脑膜瘤可获得充分的肿瘤显露和眶尖减压,手术入路安全,可有效缓解突眼症状。因肿瘤多累及眶尖、眶上裂、海绵窦等重要组织结构,肿瘤难以完全切除,术后复发率较高。
Objective To investigate the surgical methods and curative effect of transcranial approach for the removal of butterflies-orbital meningioma. Design retrospective case series. Thirty-two patients with butterflies-orbital meningiomas were enrolled in this study, including 28 cases of benign meningiomas (WHO grade Ⅰ), of which 24 were epithelial type, 3 were fibrous type and 1 was mesenchymal type. The active or atypical meningiomas (WHO grade 2) Cases; Malignant meningioma (WHO Ⅲ grade) in 2 cases. Methods The internal frontotemporal arcuate incision was used to excise the large sphenoid sphenoid bone, superior orbital fissure, open decompression of optic canal and thickened periorbital periosteum together with tumor. Fascia or artificial meninges repair dura and periorbital defects. The main indicators of preoperative and postoperative exophthalmos, eye movement and other clinical manifestations, tumor resection and recurrence rate. Results The degree of tumor resection was 8 cases of Simpson grade Ⅱ, 20 cases of Simpson Ⅲ grade and 4 cases of Simpson Ⅳ grade. Postoperative exophthalmology have improved, 6 patients were limited after outreach, 4 cases of ptosis. Follow-up of 6 patients with tumor recurrence. Conclusion Transcranial approach to remove butterflies - orbital meningioma can get adequate tumor exposure and orbital apex decompression, surgical approach safe, can effectively alleviate the symptoms of exophthalmos. Tumor involvement of orbital apex, supraorbital fissure, cavernous sinus and other important organizational structures, difficult to completely remove the tumor, postoperative recurrence rate higher.