改良额底入路切除鞍结节脑膜瘤31例

Modified frontobasal approach for tuberculum sellae meningioma resection: an analysis of 31 cases

摘要:

目的 探讨改良额底入路切除鞍结节脑膜瘤的临床效果。方法 回顾性分析本人自2009年12月至2013年12月来采取不损伤颞肌,不选传统额底入路的"关键孔"点,而选取"美容孔"点,骨瓣大小和位置选择灵活的改良额底入路切除鞍结节脑膜瘤31例的临床资料。结果 手术后4例病人癫痫未再发作,无垂体功能低下病例,无尿崩病例,无额纹消失病例,无颞肌萎缩病例。有5例术侧嗅神经断裂。术前有48只眼视力下降,术后有46只眼视力明显改善,有1只眼视力无明显变化,1只眼视力下降。simpsonⅠ级切除25例中,有1例于术后2年复发。simpsonⅡ级切除5例中,有1例于术后1.5年时复发。simpsonⅢ级切除1例,随访2.5年残余肿瘤无明显变化。结论 改良额底入路切除鞍结节脑膜瘤具有灵活、安全、暴露充分、切除彻底、损伤轻等优点。

Abstract:

Objective To investigate the clinical effect of modified frontobasal approach for tuberculum sellae meningioma resection.Methods A retrospective analysis was performed for the clinical data of 31 patients with tuberculum sellae meningiomas who underwent the modified frontobasal approach with "beauty holes" instead of "keyhole" in conventional frontobasal approach and flexible selection of bone flap size and position and without temporalis injury for tuberculum sellae meningioma resection from December 2009 to December 2013.Results After the surgery, 4 patients did not experience epileptic seizure again. No hypopituitarism, diabetes insipidus, disappearance of frontal lines, or temporal muscle atrophy was reported in these patients. Olfactory nerve fractured in 5 patients.Impaired vision was recorded in 48 eyes before surgery. Eyesight improved in 46 eyes, retained stable in 1 eye, and deteriorated in 1 eye after surgery. Among the 25 patients with Simpson grade I resection, 1 experienced recurrence at 2 years after surgery; among 5 patients with Simpson grade II resection, 1 experienced recurrence at 1.5 years after surgery; one patient with Simpson grade III resection showed no obvious changes in residual tumor during the 2.5-year follow-up.Conclusions Modified frontobasal approach for tuberculum sellae meningioma resection has the advantages of flexibility, safety, sufficient exposure, radical resection, and little trauma.