CAJ | 학술논문

目的探讨进一步提高嗅沟脑膜瘤治疗效果的有效方法.方法应用显微神经外科技术治疗嗅沟脑膜瘤67例,其中首次发病57例,复发8例,二次复发2例.术中采用改良Derome入路12例,双侧额底入路28例,改良翼点入路21例,单侧额底入路6例.肿瘤切除包括附着硬膜、肿瘤基底增生破坏的骨质以及受累的副鼻窦黏膜,最后对缺损颅底做修补重建.结果按照脑膜瘤切除的Simpson分级标准,肿瘤获Simpson Ⅰ类切除59例,Ⅱ类切除7例,Ⅳ类切除1例.术后并发脑脊液漏和颅内感染仅1例,经处理治愈.术后1个月内死亡2例(2.9%),死因分别为心衰和下丘脑损伤.47例(72.3%)患者随访1～10年,平均64个月.2例高龄患者死亡,其中1例死于肺炎,1例死因不详.45例生存患者中,复发3例,为Ⅱ类或Ⅳ类切除者,Ⅰ类切除者均无复发.除3例患者仍存在视力下降和2例患者一侧肢体轻瘫外,其余患者恢复良好,已恢复工作或能生活自理.结论全切除肿瘤(Simpson Ⅰ类)应是嗅沟脑膜瘤的手术目的,特别是新发的病例.选择适当的手术入路是全切除肿瘤的根本保证.采用适当的带血管蒂材料修补、重建前颅底是手术治疗嗅沟脑膜瘤至关重要和必须做到的.
목적 탐토진일보제고후구뇌막류치료효과적유효방법.방법 응용현미신경외과기술치료후구뇌막류67례,기중수차발병57례,복발8례,이차복발2례.술중채용개량Derome입로12례,쌍측액저입로28례,개량익점입로21례,단측액저입로6례.종류절제포괄부착경막、종류기저증생파배적골질이급수루적부비두점막,최후대결손로저주수보중건.결과 안조뇌막류절제적Simpson분급표준,종류획Simpson Ⅰ류절제59례,Ⅱ류절제7례,Ⅳ류절제1례.술후병발뇌척액루화로내감염부1례,경처리치유.술후1개월내사망2례(2.9%),사인분별위심쇠화하구뇌손상.47례(72.3%)환자수방1～10년,평균64개월.2례고령환자사망,기중1례사우폐염,1례사인불상.45례생존환자중,복발3례,위Ⅱ류혹Ⅳ류절제자,Ⅰ류절제자균무복발.제3례환자잉존재시력하강화2례환자일측지체경탄외,기여환자회복량호,이회복공작혹능생활자리.결론 전절제종류(Simpson Ⅰ류)응시후구뇌막류적수술목적,특별시신발적병례.선택괄당적수술입로시전절제종류적근본보증.채용괄당적대혈관체재료수보、중건전로저시수술치료후구뇌막류지관중요화필수주도적.
Objective To explore an effective method for further improving the surgical results of treatment of olfactory groove meningiomas.Methods Sixty seven cases of olfactory groove meningiomas were treated by microneurosurgery, among which fifty seven were de novo cases, eight were recurrent tumors and the other two re-recurrent cases.Modified Derome approach was used in 12 cases, bilateral subfrontal approach in 28 cases, modified pterional approach in 21 cases and unilateral subfrontal approach in six cases.Tumors were resected microsurgically with radical removal of invaded dura, bone, and paranasal sinus mucosa.Reconstruction was performed in patients with skull base defect.Results Simpson grade Ⅰ removal was accomplished in 59 cases, grade Ⅱ in seven cases and grade Ⅳ in one case.Among 57 patients with de novo tumor, Simpson Ⅰ resection was accomplished in 54 cases.Postoperative rhinorrhea and intracranial infection occurred in one case and was cured after temporal lumbar CSF drainage and antibiotic therapy.Two patients ( 2.9% ) died within one month after operation, i.e.one aged patient of heart failure and the other of severe hypothalamus complication.Forty seven patients(72.3% ) were followed up from one to ten years with an average of five years and four months.With the exception of two cases died,among the alive 45 patients, there were only three patients with tumor recurrence, which had undergone Simpson Ⅱ or Ⅳ tumor resection.No recurrence was found in cases with Simpson Ⅰ tumor removal.Previous blurred vision was not improved in three patients, hemiparalysis in two patients, and the other patients recovered well, resuming previous jobs or being able to take care themselves.Conclusions Total tumor removal ( Simpson Ⅰ ) should be the surgical goal for treatment of olfactory groove meningiomas,especially for de novo cases.An appropriate approach is fundamental in the effort to remove an OGM totally.Appropriate anterior skull base reconstruction with vascularized material is important and mandatory.