中华神经外科杂志
中華神經外科雜誌
중화신경외과잡지
Chinese Journal of Neurosurgery
2011年
1期
18-22
,共5页
郝淑煜%张俊廷%张力伟%谢琳%吴震%贾桂军%汤劼%肖新如%耿素民%王亮
郝淑煜%張俊廷%張力偉%謝琳%吳震%賈桂軍%湯劼%肖新如%耿素民%王亮
학숙욱%장준정%장력위%사림%오진%가계군%탕할%초신여%경소민%왕량
并发症%脑膜瘤%显微外科手术%蝶窦海绵窦%眼睑下垂
併髮癥%腦膜瘤%顯微外科手術%蝶竇海綿竇%眼瞼下垂
병발증%뇌막류%현미외과수술%접두해면두%안검하수
Complications%Meningioma%Microsurgery%Sphenocavernous%Ptosis
目的 分析蝶窦海绵窦脑膜瘤显微手术术后眼睑下垂相关因素及并发症.方法 回顾性研究首都医科大学附属北京天坛医院颅底脑干病房从1993年4月到2008年12月的49例蝶窦海绵窦脑膜瘤的治疗情况,对可能导致术后眼睑下垂的危险因素进行Logistic回归分析.结果 男41例,女38例;平均年龄52.4岁;病史平均20.9个月.最常见症状为脑神经损害,MRI发现肿瘤平均最大径为5.09 cm.30例患者采用额颞人路,14例采用额颞断颧弓人路,5例选用眶颧入路切除肿瘤.肿瘤近全切除率52%,死亡率2%.随访到39例患者,平均随访73.7个月,4例随访中死亡,生存的35例患者中,22例正常生活.多因素分析发现,术后眼睑下垂与海绵窦分级、术前KPS评分及既往手术史相关.结论 蝶窦海绵窦脑膜瘤全切困难,术后最常见并发症是动眼神经麻痹,术后眼睑下垂与海绵窦分级、术前KPS评分及既往手术史相关.术后随访发现肿瘤复发可辅助放疗.
目的 分析蝶竇海綿竇腦膜瘤顯微手術術後眼瞼下垂相關因素及併髮癥.方法 迴顧性研究首都醫科大學附屬北京天罈醫院顱底腦榦病房從1993年4月到2008年12月的49例蝶竇海綿竇腦膜瘤的治療情況,對可能導緻術後眼瞼下垂的危險因素進行Logistic迴歸分析.結果 男41例,女38例;平均年齡52.4歲;病史平均20.9箇月.最常見癥狀為腦神經損害,MRI髮現腫瘤平均最大徑為5.09 cm.30例患者採用額顳人路,14例採用額顳斷顴弓人路,5例選用眶顴入路切除腫瘤.腫瘤近全切除率52%,死亡率2%.隨訪到39例患者,平均隨訪73.7箇月,4例隨訪中死亡,生存的35例患者中,22例正常生活.多因素分析髮現,術後眼瞼下垂與海綿竇分級、術前KPS評分及既往手術史相關.結論 蝶竇海綿竇腦膜瘤全切睏難,術後最常見併髮癥是動眼神經痳痺,術後眼瞼下垂與海綿竇分級、術前KPS評分及既往手術史相關.術後隨訪髮現腫瘤複髮可輔助放療.
목적 분석접두해면두뇌막류현미수술술후안검하수상관인소급병발증.방법 회고성연구수도의과대학부속북경천단의원로저뇌간병방종1993년4월도2008년12월적49례접두해면두뇌막류적치료정황,대가능도치술후안검하수적위험인소진행Logistic회귀분석.결과 남41례,녀38례;평균년령52.4세;병사평균20.9개월.최상견증상위뇌신경손해,MRI발현종류평균최대경위5.09 cm.30례환자채용액섭인로,14례채용액섭단권궁인로,5례선용광권입로절제종류.종류근전절제솔52%,사망솔2%.수방도39례환자,평균수방73.7개월,4례수방중사망,생존적35례환자중,22례정상생활.다인소분석발현,술후안검하수여해면두분급、술전KPS평분급기왕수술사상관.결론 접두해면두뇌막류전절곤난,술후최상견병발증시동안신경마비,술후안검하수여해면두분급、술전KPS평분급기왕수술사상관.술후수방발현종류복발가보조방료.
Objective To study the surgical results and complications for sphenocavernous (SC)meningioma patients with special reference to postoperative ptosis.Method 49 consecutive cases of SC meningiomas operated between April 1993 and Dec 2008 in our department were reviewed.All the probable risk factors related to postoperative ptosis were studied with Logistic regression analysis.Results There were 38 female and 11 male patients ( mean age 52.4 years, range 31 ～ 74 years).The mean duration of symptoms was 20.9 months( ranging from 1 week to 108 months).Cranial nerves palsy was the most common presenting symptoms.The mean maximal diameter of tumor on MRI was 5.09 cm.Frontotemporal approach was performed in 30 cases,frontotemporal zygomatic approach in 14 cases and frontotemporal orbitozygomatic osteotomy approach in 5 cases.Subtotal resection was achieved in 52% patients.The surgical mortality was 2%.Follow -up data were available for 39 patients,with a mean follow- up of 73.7 months.Four patients died during follow - up period.Of the 35 living patients, 22 lived a normal life.Multi - factors that might influence ptosis after operation included the grading of cavernous extension, pre - operation KPS and the history of surgery for tumors.Conclusions Complete and safe resection of SC meningioma is difficult.Our experience suggests that the most common complication after SC meningioma surgery is ocular CN dysfunction.The factors relative to postoperative ptosis include the extension to cavernous sinus,pre - operation KPS and history of surgery for meningioma.Gamma knife radiosurgery could be considered as an adjuvant therapy only for recurrent tumors during follow - up period.
