摘要
目的：提高内侧型蝶骨嵴脑膜瘤的全切率，降低死亡率和致残率。方法：回顾性分析一组２０例病例的显微外科治疗。结果：多数表现为单眼视力下降。冠状位ＣＴ有助于判断肿瘤的生长点。ＭＲＩ可显示肿瘤与海绵窦、颈内动脉的关系。１例肿瘤侵入海绵窦，１１例肿瘤包绕颈内动脉和主要分支。肿瘤附着点为前床突和（或）小翼的内侧。１５例达ＳｉｍｐｓｏｎⅠ、Ⅱ级全切除。术后偏瘫２例，无死亡。结论：手术要点是尽早离断肿瘤基底并沿颈内动脉床突上段由近向远分离切除包绕的肿瘤。由于多数存在肿瘤与血管之间的蛛网膜界面。
Objective: To improve the total removal rate and to reduce the mortality and morbidity of medial sphenoid ridge meningiomas. Methods: A series of 20 cases were analysed retrospectively. Results: Most of the patients presented with unilateral visual loss and headache. Coronal CT was particularly helpful in identifying the origin of the lesions. The relationships between tumor and cavernous sinus, arteries (ICA, MCA, ACA) were well demonstrated on MRI. Cavernous sinus infiltration was found in one case, cavenous sinus compression in one, partial or entire vessel encasement in 11. Dural attachment of the tumors were at anterior clinoid or/and inner portion of the lesser wing. Total removal of the tumor of Simpson's 1 to 2 grade in 15 cases with postoperative hemiplegia in 2 cases, no mortality. Conclusion: In the surgical skills we suggest that the dural attachment of the lesion should be dissected along the sphenoid wing first, in order to minimize blood loss and to facilitate orientating and exposing the supraclinoidal segment of ICA, and then dissect the engulfing tumor proximally to distally. Because of the presence of interfacing arachnoid membrane in most of the cases, we advocate to remove the tumor with a vigorous attempt in the initial operation.
出处
《中华神经外科杂志》
CSCD
北大核心
1998年第2期84-86,共3页
Chinese Journal of Neurosurgery
