CAJ | 학술논문

目的探讨前床突脑膜瘤显微切除的手术技巧和疗效.方法 2003年1月至2013年3月采用经翼点或经外侧额下入路显微切除前床突脑膜瘤46例,男性16例,女性30例;年龄16～69岁,平均48.5岁.病史1个月至9年,平均24.7个月.术前CT及MRI检查示肿瘤位于前床突右侧25例,左侧21例.肿瘤最大径1.9 ～7.4 cm,平均4.4cm.术后3～6个月及此后每年门诊定期随访.回顾性分析所有患者的临床数据、影像、手术记录和预后,采用非配对资料x2检验结果连续性校正法分析患者预后影响因素.结果全切除(Simpson分级Ⅰ/Ⅱ)36例(78.3％),少量残余10例(21.7％),其中5例行伽玛刀治疗.术前视力受损患者改善21例(51.2％),保持同前16例(35.6％),视力减退9例(20.0％).出院后3～6个月,预后良好37例(80.4％),中度残疾7例(15.2％),重度残疾1例(2.2％),死亡1例(2.2％).肿瘤包裹血管(x2=4.676,P=0.031)和累及海绵窦(x2=4.973,P=0.026)是主要预后因素.42例获持续随访,随访时间4～ 107个月,平均35.1个月;末次随访时生活质量评分平均83.2分.随访中因其他疾病死亡2例,复发4例,其中2例行伽玛刀治疗,2例再手术治疗.结论肿瘤包裹血管和累及海绵窦是手术重要不良预后因素,采用适宜手术策略和技巧,经翼点或经外侧额下入路显微切除前床突脑膜瘤疗效确切、并发症少、病死率低.
목적 탐토전상돌뇌막류현미절제적수술기교화료효.방법 2003년1월지2013년3월채용경익점혹경외측액하입로현미절제전상돌뇌막류46례,남성16례,녀성30례;년령16～69세,평균48.5세.병사1개월지9년,평균24.7개월.술전CT급MRI검사시종류위우전상돌우측25례,좌측21례.종류최대경1.9 ～7.4 cm,평균4.4cm.술후3～6개월급차후매년문진정기수방.회고성분석소유환자적림상수거、영상、수술기록화예후,채용비배대자료x2검험결과련속성교정법분석환자예후영향인소.결과 전절제(Simpson분급Ⅰ/Ⅱ)36례(78.3％),소량잔여10례(21.7％),기중5례행가마도치료.술전시력수손환자개선21례(51.2％),보지동전16례(35.6％),시력감퇴9례(20.0％).출원후3～6개월,예후량호37례(80.4％),중도잔질7례(15.2％),중도잔질1례(2.2％),사망1례(2.2％).종류포과혈관(x2=4.676,P=0.031)화루급해면두(x2=4.973,P=0.026)시주요예후인소.42례획지속수방,수방시간4～ 107개월,평균35.1개월;말차수방시생활질량평분평균83.2분.수방중인기타질병사망2례,복발4례,기중2례행가마도치료,2례재수술치료.결론 종류포과혈관화루급해면두시수술중요불량예후인소,채용괄의수술책략화기교,경익점혹경외측액하입로현미절제전상돌뇌막류료효학절、병발증소、병사솔저.
Objective To investigate the microsurgical tchniques and effects for the resection of anterior clinoid meningioma (ACM).Methods Between January 2003 and March 2013,a total of 46 ACM patients were operated on via the pterion approach or lateral subfrontal approach.There were 16 male patients and 30 female patients,their mean age was 48.5 (16-69) years.Symptoms lasted from 1 month to 9 years(average 24.7 months).Preoperative CT and MRI examination showed that the tumors were located in the anterior clinoid process (25 cases on the right side,21 cases on the left side).The average maximal tumor diameter was 4.4 cm (1.9-7.4 cm).The patients were peroidly followed-up on outpatient on 3 months to 6 months,then every year postoperativelly.The clinical data,radiological findings,surgical records and outcome of patients were retrospectively analyzed,and the prognostic factors were ananlyzed by using of the unpaired data x2 test with continuity correction.Results Of fourty-six patients operated on,apparently complete removal was achieved in 36 patients (78.3％),10 patients (21.7％) had minimal residual tumors,5 of which had gamma knife radiosurgery.Preexisting visual deficit improved in 21 of 41 patients (51.2％),unchanged in 16 (35.6％),and worsened in 9 (20.0％).At 3-6 months after discharge,37 (80.4％) patients had a good recovery,7 (15.6％) patients were moderately disabled,1(2.2％) presented with severe disability,and 1 (2.2％) patient died of surgery-related causes.The tumor wrapping blood vessels (x2 =4.676,P =0.031) and violating cavernous sinus (x2 =4.973,P =0.026) were causes of unfavorable prognosis.During the mean follow-up of 35.1 months (range,4-107 months) for 40 patients,the average Karnofsky score was 83.2.Tumor recurred in 4 cases:2 of which required reoperation,and 2 had gamma knife radiosurgery.Conclusions Tumor wrapped vessels and invasion of the cavernous sinus are important unfavorable prognostic factors for ACM resection.By using appropriate surgical strategies and techniques,ACM can be removed safely via the pterion approach or lateral subfrontal approach with relatively low morbidity and mortality.