鞍区脑膜瘤的临床特征及手术治疗策略

Clinical feature and surgical strategy for sellar region meningioma

摘要:

目的：探讨鞍区脑膜瘤的临床特征及手术治疗策略。方法：回顾性分析我院经手术治疗鞍区脑膜瘤49例临床资料，比较鞍上型与鞍旁型脑膜瘤的临床特征，对比单侧额下入路与翼点入路的差异，总结鞍区脑膜瘤手术治疗策略。结果：鞍上型21例，鞍旁型28例，鞍上型脑膜瘤对视力、视野的影响及对垂体、视神经压迫较鞍旁型更常见（P<0.05）。49例鞍区脑膜瘤，全切33例（Simpson Ⅰ级、Ⅱ级），次全切14例（Simpson Ⅲ级），部分切除（Simpson Ⅳ级）2例，全切率为67.3%。单侧额下入路与翼点入路相比，术中出血量、手术时间及术后住院时间均无差异（P >0.05）。结论：鞍上型与鞍旁型脑膜瘤的临床特点具有差异，前者对视力、视野的影响及对垂体、视神经压迫更常见。在保留患者神经功能及生活质量的基础上，最大程度切除肿瘤是主要目的，单侧额下入路及翼点入路均能使鞍区肿瘤获得良好暴露，对比术中出血量、手术时间及住院时间无明显差异。

Abstract:

Objective：To summarize and to explore the clinical features and surgical strategies for sellar region meningioma. Methods： Clinical data of 49 cases of sellar region meningioma treated by surgery in our hospital were analyzed retrospectively. Clinical features of suprasellar and parasellar meningiomas were analyzed；differences between unilateral subfrontal approach and pterional approach were compared and surgical strategies of sellar region meningioma were summarized. Results：Vision and visual field damage and pitu－itary compress were more common in suprasellar meningioma. Among 49 cases of sellar region meningioma，total removal was made in 33 cases（Simpson Ⅰ，Ⅱ）while subtotal removal in 14 cases（Simpson Ⅲ）and partial removal in 2 cases（Simpson Ⅳ）. Total removal rate was 67.3%. There was no difference in intraoperative blood loss，operative time and postoperative hospital stay between two main different types of surgical approach（unilateral frontal approach and pterional approach）（P>0.05）. Conclusion：Suprasellar and parasellar meningiomas have different clinical features；vision and visual field damage and compresssion of pituitary is more common in the former. On the basis of preserving nerve function and quality of life，maximum resection is the main direction. Unilateral sub－frontal approach and pterional approach both achieve good exposure of sellar region. No difference in intraoperative blood loss，oper－ative time and postoperative hospital stay are observed.