中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2011年
1期
44-47
,共4页
李学记%万经海%钱海鹏%左赋兴%韩利江
李學記%萬經海%錢海鵬%左賦興%韓利江
리학기%만경해%전해붕%좌부흥%한리강
脑膜瘤%鞍结节%显微神经外科
腦膜瘤%鞍結節%顯微神經外科
뇌막류%안결절%현미신경외과
Meningioma%Tuberculum sellae%Microneurosurgery
目的 总结、分析巨型鞍结节脑膜瘤(MTSM)的病理解剖及血供特点,探讨其相应的显微外科治疗对策.方法 回顾分析1998至2010年应用显微神经外科技术、理念,针对MTSM独特的病理解剖、血供特点,采取颅底入路、术中控制性降压、利用"肿瘤通道"原位切除的16例巨型鞍结节脑膜瘤患者的临床资料,其中男5例,女11例,年龄26～65岁,平均48.5岁;随访14例,时间4～132个月,平均74.9个月.结果 肿瘤最大径51.1～76.2 mm,平均5 8.9 mm;Simpson Ⅰ、Ⅱ、Ⅲ及Ⅳ级切除分别为3、9、3及1例;术后死亡1例,视力不同程度好转10例,无变化2例,恶化2例,短暂尿崩9例.结论 深入研究MTSM独特的血供、病理解剖特点至关重要,针对性地采取相应的显微外科对策、利用"肿瘤通道"原位手术切除应为MTSM较为理想的治疗方案.
目的 總結、分析巨型鞍結節腦膜瘤(MTSM)的病理解剖及血供特點,探討其相應的顯微外科治療對策.方法 迴顧分析1998至2010年應用顯微神經外科技術、理唸,針對MTSM獨特的病理解剖、血供特點,採取顱底入路、術中控製性降壓、利用"腫瘤通道"原位切除的16例巨型鞍結節腦膜瘤患者的臨床資料,其中男5例,女11例,年齡26～65歲,平均48.5歲;隨訪14例,時間4～132箇月,平均74.9箇月.結果 腫瘤最大徑51.1～76.2 mm,平均5 8.9 mm;Simpson Ⅰ、Ⅱ、Ⅲ及Ⅳ級切除分彆為3、9、3及1例;術後死亡1例,視力不同程度好轉10例,無變化2例,噁化2例,短暫尿崩9例.結論 深入研究MTSM獨特的血供、病理解剖特點至關重要,針對性地採取相應的顯微外科對策、利用"腫瘤通道"原位手術切除應為MTSM較為理想的治療方案.
목적 총결、분석거형안결절뇌막류(MTSM)적병리해부급혈공특점,탐토기상응적현미외과치료대책.방법 회고분석1998지2010년응용현미신경외과기술、이념,침대MTSM독특적병리해부、혈공특점,채취로저입로、술중공제성강압、이용"종류통도"원위절제적16례거형안결절뇌막류환자적림상자료,기중남5례,녀11례,년령26～65세,평균48.5세;수방14례,시간4～132개월,평균74.9개월.결과 종류최대경51.1～76.2 mm,평균5 8.9 mm;Simpson Ⅰ、Ⅱ、Ⅲ급Ⅳ급절제분별위3、9、3급1례;술후사망1례,시력불동정도호전10례,무변화2례,악화2례,단잠뇨붕9례.결론 심입연구MTSM독특적혈공、병리해부특점지관중요,침대성지채취상응적현미외과대책、이용"종류통도"원위수술절제응위MTSM교위이상적치료방안.
Objective To summarize the characteristics of the pathological anatomy and blood supply model of massive tuberculum sellae meningiomas (MTSM) and explore its corresponding microneurosurgical strategies. Methods The clinical data of 16 MTSM patients were reviewed retrospectively. From January 1998 to January 2010, according to their unique pathological anatomy and blood supply model, all patients underwent microneurosurgical removal with induced hypotension through tumor corridor by the bi-subfrontal anterior longitudinal fission ( n = 14), right frontolateral approach ( n =1 ) and pterional approach (n = 1 ). There were 5 males and 11 females with a mean age of 48. 5 years old ( range: 26 - 65 ). But the mean follow-up period was 74. 9 months ( range: 4 - 132) in 2/4 cases. Results Among all cases, the mean tumor diameter was 58.9 mm ( range: 51.1 - 76. 2 mm). Simpson grade Ⅰ, Ⅱ ,Ⅲ, Ⅳ removal of MTSMs were accomplished in 3, 9, 3 and 1 case respectively. One case died within 4postoperative days. Visual acuity improved in 10 patients, remained unchanged in 2 and deteriorated in 2.Transient postoperative diabetes insipidus occurred in 9 cases. Conclusion It is critical to understand the unique characteristics of pathological anatomy and blood supply model of MTSM so as to adopt proper microneurosurgical strategies to remove it in situ.
