摘要目的 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.

abstractsObjective 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.