显微手术切除脑中央区双侧巨大脑膜瘤.pdfVIP

显微手术切除脑中央区双侧 巨大脑膜瘤 何升学 张岩松 刘宏毅 常义 刘翔 马骏 邹元杰 胡新华 杨坤 [摘要] 目的 探讨显微外科技术在脑中央区双侧镰旁巨大脑膜瘤手术中的应用。方法 采 用跨中线骨瓣、条状硬脑膜瓣、向对侧牵引上矢状窦和经单侧纵裂切除双侧肿瘤等显微手术技术，切 除16例脑中央区双侧镰旁巨大脑膜瘤。结果 肿瘤均为SimpsonⅠ级切除，术后症状较术前改善 13例，与术前相同3例，无手术死亡；术后随访6个月-5年，全部患者均未见肿瘤复发。结论 应 用显微外科技术能够较好地避免过度牵拉脑叶，减少功能区脑皮层和重要回流静脉的损伤，消除了 上矢状窦对大脑镰的 “屋檐效应”，有利于肿瘤的暴露和完全切除。 脑膜瘤；显微外科手术；脑中央区 Microsurgicalresectionofbilateralfalcinemeningiomasincentralgyrusregion HESheng-xue ZHANGYan-songLIUHong-yiCHANG YiLIUXiangMAJunZOUYuan-jie,HUXin-hua,YANG Kun DepartmentofNeurosurgery, BrainHospitalAffiliatedtoNanjingMedical University, Nanjing 210029,China [Abstract] Objective Toinvestigatemicrosurgicaltechniquesinbilateralfalcinemeningiomasof centralgyrusregionsurgery.Methods Sixteenpatientswithbilateralfalcinemeningiomasincentralgyrus regionweretreatededwithaseriesofmicrosurgicaltechniques,includingmidline-crossingcraniotomy, duralcutinastripfashionwithaflapbasedonthesuperiorsagittalsinus,retractionofthesuperiorsagittal sinustowardtheoppositesideandanipsilateralinterhemisphericfissureapproach.Theclinicaldataand prognosiswassummarized.Results SimpsonⅠgraderemovalwasachievedinallpatients.Theneurological functionswereimprovedin13cases,unchangedin3casespostoperatively.Therewasnopostoperative death.Thefollowupperiodofpatientsrangedfrom6to60monthsandnotumorrecurrencewas observed.Conclusion Applicationofminimallymicrosurgicaltechniquescanbebettertoavoidover -stretchthebrainleaves,reducesignificantdamagetoeloquentcerebralcortexaswellasvenousreflux, andeliminatethe “eaveseffect” ofthesuperiorsagittalsinustothefalxinfavorofexposureandcomplete resectionoftumor. Meningioma; Microsurgery;Centralgyrusregion 10.3760/cma.j.issn.1001-2346.2011.04.025 210029 南京医科大学附属脑科医院神经外科 结 果 @@[1] LanmanTH, BecketDP. Falcinemeningiomas.//Al-MeftyO, ed.Meningiomas.NewYork:RavenPress,1991:345-356. @@[2]张岩松，常义，惠国桢，等.颞叶桥静脉引流形式的显微外科 解剖研究.中华神经外科杂志，2005，21:21-23.