CAJ | 학술논문

目的探讨前床突脑膜瘤(ACMs)的手术治疗策略和显微外科手术技巧.方法回顾性分析手术治疗的49例ACMs患者的临床、影像学、术中和随访资料.结果肿瘤Simpson Ⅰ级切除3例、Ⅱ级25例,Ⅲ级12例,Ⅳ级9例.术前有视力下降的30例中,术后视力恶化3例,无变化15例,视力改善12例.术后永久性并发症10例,除上述3例视力恶化者外,新发视力下降1例,轻偏瘫4例,部分性动眼神经麻痹2例.结论选择合适的手术策略,术中辨认肿瘤与重要结构的蛛网膜界面,保护血管和神经是安全切除ACMs的保障.
목적 탐토전상돌뇌막류(ACMs)적수술치료책략화현미외과수술기교.방법 회고성분석수술치료적49례ACMs환자적림상、영상학、술중화수방자료.결과 종류Simpson Ⅰ급절제3례、Ⅱ급25례,Ⅲ급12례,Ⅳ급9례.술전유시력하강적30례중,술후시력악화3례,무변화15례,시력개선12례.술후영구성병발증10례,제상술3례시력악화자외,신발시력하강1례,경편탄4례,부분성동안신경마비2례.결론 선택합괄적수술책략,술중변인종류여중요결구적주망막계면,보호혈관화신경시안전절제ACMs적보장.
Objective To investigate the surgical strategies and microsurgical techniques for anterior clinoidal meningiomas(ACMs).Methods A retrospective analysis of the clinical,radiographic,operative,and follow - up data was performed in 49 patients with ACMs who underwent surgical resection in our department between January 2000 to June 2011.Results The mean size of the tumors was 4.4 cm (range 2 ～7 cm).Simpson grade Ⅰ resection was achieved in 3 cases(6％ ),grade Ⅱ in 25(51％ ),grade Ⅲ in 12(25％ )and grade Ⅳ in 9 (18％).The mean follow- up period was 31.1months (ranged from 3 to 111months).Among the 30 patients with preoperative visual impairment,the visual acuity was improved in 12 cases (40％),unchanged in 15 ( 50％ ) and worsened in 3 ( 10％ ).New permanent postoperative neurological deficits were observed in 10 cases:1patient with new visual deficit,3 worsening of preexisting visual deficits,4 hemiparesis and 2 partial oculomotor nerve paresis.Conclusions ACMs consistently involve the unilateral arteries of the anterior cerebral circulation and optic apparatus.Constant microsurgical surveillance of the arterial tree and maintenance of the cerebrospinal fluid interface between the tumor and involved arteries and nerves are the most important operative nuances for safe tumor resection.