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目的:探讨鞍结节脑膜瘤的显微手术治疗方法。方法:回顾性分析20例鞍结节脑膜瘤患者的临床资料,20例患者,男性8例,女性12例;年龄34~65岁,平均47.1岁;病程2个月~3年;肿瘤直径<4cm的11例中,采用翼点入路7例,单侧额下入路4例;肿瘤直径>4cm的9例中,采用双测额下入路2例,翼点加纵裂复合入路7例。结果:肿瘤全切(SimpsonⅠ级+Ⅱ级)16例(80%),其中翼点加纵裂复合入路7例均获得肿瘤全切,SimpsonⅢ级切除4例(20%)。在有视力下降的18例患者29只眼中,术后视力改善20只眼(69.0%),无改变7只眼(24.1%),加重2只眼(6.9%),其中术前单眼视力严重下降者术后均无恢复。翼点加纵裂复合入路7例中视力改善6例,无改变1例。结论:保护对视神经供血的穿支血管,注意肿瘤侵入视神经管情况,是视神经功能保护的关键。
Objective: To explore the microsurgical treatment of saddle nodular meningioma. Methods: A retrospective analysis of 20 patients with saddle nodular meningioma clinical data, 20 patients, 8 males and 12 females; aged 34 to 65 years, mean 47.1 years; duration of 2 months to 3 years; tumor diameter < 4cm in 11 cases, the use of pterional approach in 7 cases, unilateral inferior frontal approach in 4 cases; tumor diameter> 4cm in 9 cases, the use of double measurement of the next approach in 2 cases, the wing point plus longitudinal split composite approach 7 cases. Results: Totally 16 cases (80%) with complete resection of the tumor (Simpson grade Ⅰ and Ⅱ), of which 7 cases were allotomized with pterional point plus longitudinal incision and composite approach. Four cases (20%) were Simpson Ⅲ resection. In 29 eyes of 18 eyes with decreased visual acuity, postoperative visual acuity was improved in 20 eyes (69.0%), no change in 7 eyes (24.1%) and exacerbation in 2 eyes (6.9%), preoperative monocular vision was significantly decreased No postoperative recovery. 7 points in the wing point plus longitudinal splitting approach to improve visual acuity in 6 cases, no change in 1 case. Conclusion: Protecting the perforator blood supply to the optic nerve and paying attention to the invagination of the tumor into the optic canal of the optic nerve is the key to the functional protection of the optic nerve.