嗅沟脑膜瘤的显微外科治疗
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摘要
目的探讨显微手术切除嗅沟脑膜瘤的手术方法与疗效。方法回顾性分析41例经显微外科手术治疗嗅沟脑膜瘤患者的临床资料及术后随访情况。结果按照Simpson切除标准,Ⅰ级切除30例(73.17%),Ⅱ级切除9例(21.95%),Ⅲ级切除2例(4.88%)。术后并发症:精神症状9例,癫痫2例,皮下积液6例,额叶出血1例,术后经积极治疗后病愈出院;无肢体功能障碍、脑脊液漏、颅内感染及死亡病例。术后获得随访患者29例,随访时间3～12个月,均无复发。结论根据肿瘤大小及生长方向采用不同的手术入路,适合的颅底重建,显微手术切除嗅沟脑膜瘤可达到满意的疗效。
Objective To evaluate the methods and outcomes of microsurgical treatment of olfactory groove meningioma.Methods The clinical data of 41 cases underwent the operation from January 2005 to December 2011 were analyzed retrospectively.Results According to Simpson Grading of meningioma resection,30(73.17%) cases received Grade Ⅰ resection,9(21.95%) cases received Grade Ⅱ resection,2(4.88%) cases received Grade Ⅲ resection.The complications included the psychiatric symptoms in 9 patients,epilepsy in 2 patients,scalp hydrops in 6 patients and frontal hemorrhage in 1 patient.No patient died or no cerebrospinal fluid leaks,intracranial infection and other severe complications from the operation occurred.No tumor recurred in 29 cases who were followed up from 3 to 12 months.Conclusion The meningioma located at olfactory groove can be totally resected by microsurgical techniques.Satisfactory outcomes can be obtained by the proper choice of surgical approach and the microsurgical techniques according to the size and growth direction of the tumor.
Objective To evaluate the methods and outcomes of microsurgical treatment of olfactory groove meningioma.Methods The clinical data of 41 cases underwent the operation from January 2005 to December 2011 were analyzed retrospectively.Results According to Simpson Grading of meningioma resection,30(73.17%) cases received Grade Ⅰ resection,9(21.95%) cases received Grade Ⅱ resection,2(4.88%) cases received Grade Ⅲ resection.The complications included the psychiatric symptoms in 9 patients,epilepsy in 2 patients,scalp hydrops in 6 patients and frontal hemorrhage in 1 patient.No patient died or no cerebrospinal fluid leaks,intracranial infection and other severe complications from the operation occurred.No tumor recurred in 29 cases who were followed up from 3 to 12 months.Conclusion The meningioma located at olfactory groove can be totally resected by microsurgical techniques.Satisfactory outcomes can be obtained by the proper choice of surgical approach and the microsurgical techniques according to the size and growth direction of the tumor.
引文
1 Gazzeri R,Galarza M,Gazzeri G.Giant olfactory groove menigioma:ophthalmological and cognitive outcome after bifrontal microsurgicalapproach[J].Acta Neurochir,2008,150(11):1117-1125.
2 Tomasello F,Angileri FF,Grasso G,et al.Giant olfactory groovemeningiomas:extent of frontal lobes damage and long-term outcomeafter the pterional approach[J].World Neurosurgery,2011,76(3-4):311-317.
3钱忠心,赵鸿,朱景伟,等.大型嗅沟脑膜瘤外科治疗附18例报告[J]:中国神经肿瘤杂志,2010,8(2):105-108.
4何佳宏,肖益安,罗湘辉,等.嗅沟脑膜瘤的显微手术治疗[J].中国微侵袭神经外科杂志,2010,15(8):359-360.
5 González-Darder JM,Pesudo-Martínez JV,Bordes-García V,et al.Olfactory groove meningiomas.Radical microsurgical treatment through thebifrontal approach[J].Neurocirugia(Astur),2011,22(2):133-139.
6 Aguiar PH,Tahara A,Almeida AN,et al.Olfactory groovemeningiomas:approaches and complications[J].J Clin Neurosci,2009,16(9):1168-1173.
7 Liang RS,Zhou LF,Mao Y.Microsurgical removal of olfactory groovemeningiomas[J].Zhonghua Zhong Liu Za Zhi,2011,33(1):70-75.
8 Welge-Luessen A,Temmel A,Quint C,et al.Olfactory function in pa-tients with olfactory groove meningioma[J].J Neurol NeurosurgPsychiatry,2001,70(2):218-211.
9 Hentschel SJ,Demonte F.Olfactory groove meningiomas[J].Neurosurg Focus,2003,14(6):e4.
10 Abe T,Goda M,KamidaT,et al.Overlapping free bone graft withgalea-pericranium in reconstruction of the anterior skull base to preventCSF leak and sequestrum formation[J].Acta Neurochir(Wien),2007,149(8):771-775.
2 Tomasello F,Angileri FF,Grasso G,et al.Giant olfactory groovemeningiomas:extent of frontal lobes damage and long-term outcomeafter the pterional approach[J].World Neurosurgery,2011,76(3-4):311-317.
3钱忠心,赵鸿,朱景伟,等.大型嗅沟脑膜瘤外科治疗附18例报告[J]:中国神经肿瘤杂志,2010,8(2):105-108.
4何佳宏,肖益安,罗湘辉,等.嗅沟脑膜瘤的显微手术治疗[J].中国微侵袭神经外科杂志,2010,15(8):359-360.
5 González-Darder JM,Pesudo-Martínez JV,Bordes-García V,et al.Olfactory groove meningiomas.Radical microsurgical treatment through thebifrontal approach[J].Neurocirugia(Astur),2011,22(2):133-139.
6 Aguiar PH,Tahara A,Almeida AN,et al.Olfactory groovemeningiomas:approaches and complications[J].J Clin Neurosci,2009,16(9):1168-1173.
7 Liang RS,Zhou LF,Mao Y.Microsurgical removal of olfactory groovemeningiomas[J].Zhonghua Zhong Liu Za Zhi,2011,33(1):70-75.
8 Welge-Luessen A,Temmel A,Quint C,et al.Olfactory function in pa-tients with olfactory groove meningioma[J].J Neurol NeurosurgPsychiatry,2001,70(2):218-211.
9 Hentschel SJ,Demonte F.Olfactory groove meningiomas[J].Neurosurg Focus,2003,14(6):e4.
10 Abe T,Goda M,KamidaT,et al.Overlapping free bone graft withgalea-pericranium in reconstruction of the anterior skull base to preventCSF leak and sequestrum formation[J].Acta Neurochir(Wien),2007,149(8):771-775.