伴有视力障碍的内侧型蝶骨嵴脑膜瘤治疗及预后分析
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摘要
目的:探讨伴有视力障碍的内侧型蝶骨嵴脑膜瘤的手术治疗及术后视力改善情况。方法:回顾性分析我院手术治疗的32例伴有视力障碍的内侧型蝶骨嵴脑膜瘤患者的临床资料及术后随访信息,应用SPSS 13.0统计软件包,对肿瘤大小、肿瘤是否全切及术后视力情况进行卡方检验分析。结果:32例内侧型蝶骨嵴脑膜瘤患者,视力改善20例,未改善12例;肿瘤全切21例,次全切除8例,大部切除3例。术前有视神经萎缩的8例患者,术后随访6例视力无变化,2例视力恶化。小型肿瘤手术后视力改善(改善率90.0%)优于肿瘤较大者(大型及巨大型50.0%);肿瘤全切患者的视力改善(改善率81.0%)优于未全切者(改善率27.3%)。2例术中同时行视神经减压术的患者,术后视力均有不同程度的改善。结论:伴有视力障碍的内侧型蝶骨嵴脑膜瘤患者应尽早手术治疗,术后视力改善与术前肿瘤大小、是否全切及术前有无视神经萎缩有关,对于未行全切的mSRM,术后应行辅助治疗。术中精细轻柔操作,熟悉局部解剖并准确定位,良好显露,可最大限度的降低术中视神经损伤,并能最大限度切除视神经周围的肿瘤,有效保护其供血动脉,必要时行视神经减压术,这些均可对视力的预后有直接的积极作用。
Objective:To discuss the surgery and postoperative improvements in visual acuity of medial sphenoid ridge meningiomas associated with visual impairment. Methods: Retrospectively analyze the clinical datas and the follow-up results of 32 cases of medial sphenoid ridge meningiomas associated with visual impairment in our hospital. And made a chi-square analysis of the tumor sizes, the resection situations and the post-operative visual acuity improvements using SPSS 13.0 statistical software package. Results:Of the 32 cases, 20 cases had improvements in visual acuity, 12 cases unchanged. Tumor gross total resection was achieved in 21, subtotal in 8, large partial in 3. Preoperatively 8 cases had optic atrophy, 6 cases remained unchanged visual acuity postoperatively, and 2 cases had deteriorations. Improvement of visual acuity in small size tumors was better (improvement rate 90.0%) than that of great size tumors (improvement rate 50.0%). Improvement of visual acuity in gross total resection was better (improvement rate 81.0%) than that of subtotal resection (improvement rate 27.3%). Conclusion:Visually impaired patients with medial sphenoid ridge meningiomas should get surgery as soon as possible. The improvements of visual acuity of the medial sphenoid ridge meningiomas were associated with the tumor sizes, whether gross total resection and optic atrophy or not. So, Intraoperative gentle operations, accurate positioning, good exposures, will surely make a great help in reducing the damage during operation maximumly and in the safely resection of the tumors around the optic nerve. protecting its supply arteris As far as possible and make an optic nerve decompression if necessary all will produce obvious effects to the visual prognosis with medial sphenoid ridge meningiomas.
Objective:To discuss the surgery and postoperative improvements in visual acuity of medial sphenoid ridge meningiomas associated with visual impairment. Methods: Retrospectively analyze the clinical datas and the follow-up results of 32 cases of medial sphenoid ridge meningiomas associated with visual impairment in our hospital. And made a chi-square analysis of the tumor sizes, the resection situations and the post-operative visual acuity improvements using SPSS 13.0 statistical software package. Results:Of the 32 cases, 20 cases had improvements in visual acuity, 12 cases unchanged. Tumor gross total resection was achieved in 21, subtotal in 8, large partial in 3. Preoperatively 8 cases had optic atrophy, 6 cases remained unchanged visual acuity postoperatively, and 2 cases had deteriorations. Improvement of visual acuity in small size tumors was better (improvement rate 90.0%) than that of great size tumors (improvement rate 50.0%). Improvement of visual acuity in gross total resection was better (improvement rate 81.0%) than that of subtotal resection (improvement rate 27.3%). Conclusion:Visually impaired patients with medial sphenoid ridge meningiomas should get surgery as soon as possible. The improvements of visual acuity of the medial sphenoid ridge meningiomas were associated with the tumor sizes, whether gross total resection and optic atrophy or not. So, Intraoperative gentle operations, accurate positioning, good exposures, will surely make a great help in reducing the damage during operation maximumly and in the safely resection of the tumors around the optic nerve. protecting its supply arteris As far as possible and make an optic nerve decompression if necessary all will produce obvious effects to the visual prognosis with medial sphenoid ridge meningiomas.
引文
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[3]赵继宗,主编.颅脑肿瘤外科学[M].北京:人民卫生出版社,2004.1032-1036.
[4] Claus EB, Bondy ML, Schildkraut JM,et al. Epidemiology of intracranial meningioma[J]. Neurosurgery, 2005, 57(6): 1088-1095.
[5]郭振宇,师蔚,张新文.蝶骨嵴内1/3脑膜瘤的超声刀显微神经外科治疗[J].中华神经医学杂志,2006,5(8):837-839.
[6]孙红卫,宋来君,张志强,等.内侧型蝶骨嵴脑膜瘤分型及治疗[J].中华神经外科杂志,2006,22(7): 396-398.
[7]罗毅男,葛鹏飞,付双林.蝶骨嵴内侧大型脑膜瘤的显微手术切除[J].中华显微外科杂志,2006,29(1):71-72.
[8]郭金满,易书贵.内侧型蝶骨嵴脑膜瘤显微手术治疗分析[J].中国实用神经疾病杂志,2007,10(8):108-109.
[9] Russell, Stephen M, Benjamin, et al. Medial sphenoid ridge meningiomas: classification, microsurgical anatomy, operative nuances, and long-term surgical outcome in 35 consecutive patients [J]. Neurosurgery, 2008, 62(6 suppl 3): 38-50.
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