巨大脑膜瘤36例手术治疗探析.docVIP

巨大脑膜瘤36例手术治疗探析 　 作者：白西民，党俊涛，姚胜，周东升，赵金安，魏栋辉，冯毅，杨军，杜春亮 ［摘要］ 目的 探讨巨大脑膜瘤的术前评估、手术入路、手术方式，总结治疗效果。方法 回顾性分析36例巨大脑膜瘤患者的临床表现、影像学资料、手术切除程度。结果 患者平均年龄51.6岁。主要临床表现是头痛、头晕、呕吐、癫痫，步态不稳，视乳头水肿。肿瘤全切（SimpsonⅠ、Ⅱ级切除）31例（83.3%），次全切5例（13.9%）,死亡1例。随访33例（91.7%），恢复工作28例，生活自理4例，生活不能自理1例。3例次全切除者随访3年，未见肿瘤生长，1例次全切除者术后2.2年残余肿瘤继续生长，因家庭经济困难未考虑再次手术。结论 术前根据肿瘤的位置、周围结构确定手术入路，先瘤内分块切除，再从瘤周分离，可以减少出血，提高肿瘤全切率。 　　［关键词］ 脑膜瘤；手术 　　Surgery treatment of enormous meningiomas 　　［Abstract］ Objective To explore former operation evaluate,the surgical approach,resection way of largenees meningiomas and summarize the effect of treatment.Methods A retrospective study was done on 36 patients with enormous meningiomas.The clinical presentation,neuroradiological data,the extent of resection analysed.Results The average age was 51.6 years.The common clinical manifestation were headache,head dizzy,vomit,epilepsia,gait ataxia and hemianopia.Total removal(Simpson group I and II) in 30(83.3%) patient subtotal removal in 5(13.9%) and one patient died.33(91.7%) cases were followed-up,28 cases were resumed work,4 cases were resumed normal life and 1 cases was not able to self life.Three cases with subtotal removal were followed-up for 3 years,no residual tumor progression.One case of subtotal removal was followed-up for 2.2 years,has residual tumor progression and no reoperation for no money.Conclusion Surgical approach according to the site and the surrounding structure of the tumor,first removed in tumor then separated around tumor.Achieved the goal reduce bleeding and raised the rate of tumor for total removal. 　　［Key words］ meningioma;operation 　　我院1997年6月～2006年6月共收治颅内巨大脑膜瘤36例，均经手术治疗和病理证实，取得了良好效果。现报告如下。 　　1 资料与方法 　　1.1 一般资料 本组患者共36例，男16例，女20例，年龄16～78岁，平均51.6岁；病程0.4~5年，平均2.3年。 　　1.2 临床表现 本组主要首发症状为头痛、头晕26例，呕吐15例，癫痫4例，步态不稳3例，视力下降2例，听力下降1例，精神异常1例。神经系统检查：双侧视乳头水肿20例，Foster-Kennedy综合征5例,肢体轻度偏瘫4例，轻度失语3例，一侧椎体束征阳性3例。 　　1.3 影像学检查 36例均行头颅CT检查，21例同时做CT和MRI检查，肿瘤位于大脑凸面9例，矢状窦旁8例，大脑镰旁5例，嗅沟4例，蝶骨嵴3例,小脑幕2例,中颅窝底2例,侧脑室2例,桥小脑角区1例。肿瘤最大径11.5 cm，7～8 cm