摘要目的 探讨前床突脑膜瘤(ACMs)的手术治疗策略和显微外科手术技巧.方法 回顾性分析手术治疗的49例ACMs患者的临床、影像学、术中和随访资料.结果 肿瘤Simpson Ⅰ级切除3例、Ⅱ级25例,Ⅲ级12例,Ⅳ级9例.术前有视力下降的30例中,术后视力恶化3例,无变化15例,视力改善12例.术后永久性并发症10例,除上述3例视力恶化者外,新发视力下降1例,轻偏瘫4例,部分性动眼神经麻痹2例.结论 选择合适的手术策略,术中辨认肿瘤与重要结构的蛛网膜界面,保护血管和神经是安全切除ACMs的保障.

abstractsObjective To investigate the surgical strategies and microsurgical techniques for anterior clinoidal meningiomas(ACMs).Methods A retrospective analysis of the clinical,radiographic,operative,and follow - up data was performed in 49 patients with ACMs who underwent surgical resection in our department between January 2000 to June 2011.Results The mean size of the tumors was 4.4 cm (range 2 ～7 cm).Simpson grade Ⅰ resection was achieved in 3 cases(6％ ),grade Ⅱ in 25(51％ ),grade Ⅲ in 12(25％ )and grade Ⅳ in 9 (18％).The mean follow- up period was 31.1months (ranged from 3 to 111months).Among the 30 patients with preoperative visual impairment,the visual acuity was improved in 12 cases (40％),unchanged in 15 ( 50％ ) and worsened in 3 ( 10％ ).New permanent postoperative neurological deficits were observed in 10 cases:1patient with new visual deficit,3 worsening of preexisting visual deficits,4 hemiparesis and 2 partial oculomotor nerve paresis.Conclusions ACMs consistently involve the unilateral arteries of the anterior cerebral circulation and optic apparatus.Constant microsurgical surveillance of the arterial tree and maintenance of the cerebrospinal fluid interface between the tumor and involved arteries and nerves are the most important operative nuances for safe tumor resection.