脊髓髓内神经鞘瘤的手术治疗.DOC

作者简介：钟东（1967-），男，重庆市人，汉族，医学博士，副主任医师、副教授，主要从事神经外科肿瘤方面的研究，发表论文20余篇。电话：（023E-mail：yy11111yy@ 显微神经外科手术切除加术后伽玛刀联合治疗窦汇区脑膜瘤的临床经验 钟东，唐文渊，谭云，陈贵杰（重庆医科大学附属第一医院神经外科 重庆400016） 摘要 目的 探讨显微神经外科手术切除加术后伽玛刀联合治疗窦汇区脑膜瘤的有效性。 方法 回顾性分析2006～2011年间15例经手术及病理证实的窦汇区脑膜瘤患者的临床资料。依据肿瘤基底附着部位和主体生长方向选择不同的手术入路，分别采用经枕下幕上入路、经幕上下联合入路及经幕下小脑上入路。 结果 15例窦汇区脑膜瘤患者手术达Simpson = 1 \* ROMAN I级切除者1例；手术达Simpson = 2 \* ROMAN II级切除者2例；Simpson = 3 \* ROMAN III～ = 4 \* ROMAN IV级切除者12例。所有病人手术顺利，术后恢复良好，无死亡病例。术后对未达Simpson = 1 \* ROMAN I～ = 2 \* ROMAN II级切除的12例患者行伽玛刀联合治疗，术后随访1～5年，无死亡病例，未见肿瘤复发。 结论 窦汇区脑膜瘤术后有残余肿瘤的患者联合伽玛刀治疗可有效降低窦汇区脑膜瘤术后复发率。 关键词 窦汇区脑膜瘤；显微神经外科手术；伽玛刀联合治疗 中国图书资料分类号 R739.42 文献标识码 A Microneurosurgery and Gamma Knife radiosurgery therapeutic alliance in the management of confluens sinus meningiomas． ZHONG Dong，TANG Wenyuan，TAN Yun，CHEN Guijie（Department of Neurosurgery, The First Affiliated Hospital of Chongqing University of Medical Sciences, Chongqing 400016, China） Abstract Objective To evaluate outcome of patients who have undergone microneurosurgery and Gamma knife Radiosurgery for confluens sinus meningiomas. Methods The clinical data, including general information, method of treatment and therapeutic effect of 15 benign confluens sinus meningiomas treated by microneurosurgery and Gamma Knife radiosurgery during 2006 to 2011 were studied retrospectively. Results 15 patients were resected via different approaches and operative methods，Such as peeling the out-layer，patching the defece of the wall. According to Simpson’s classification，Simpson Grade = 1 \* ROMAN I was achieved in 1 patients, Simpson Grade = 2 \* ROMAN II was achieved in 2 patients, Simpson Grade = 3 \* ROMAN III～ = 4 \* ROMAN IV was achieved in 12 patients. 12 patients who cannot be achieved Simpson Grade = 1 \* ROMAN I～ = 2 \* ROMAN II resection underwent the Gamma knife therapy after surgery. 15 patients were followed up systematically for 1 to 5 years. The clinical conditions improved significantly in 13 patients, rem