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目的本文分析并探讨了64例小脑幕脑膜瘤的分型、手术入路和方法。方法本文总结了1990年至2006年期间,64例小脑幕脑膜瘤(女39,男25)行手术治疗。患者年龄19~73岁(平均43岁)。临床表现为头痛(38例)、共济失调(33例)、头昏(28例)、听力下降/耳鸣(15例)、癫痫(8例)、颅神经损害(29例)。脑膜瘤分为三型:Ⅰ型(幕上型):肿瘤主体位于幕上17例;Ⅱ型(幕下型):肿瘤主体位于幕下32例;Ⅲ型哑铃型(幕上下型)15例:肿瘤向幕上下发展。其中,又根据肿瘤主体发展方向分为两个亚型:Ⅲa型4例:肿瘤主体位于幕上,向幕上发展;Ⅲb11例:肿瘤主体位于幕上,向幕下发展。结果所有患者均行手术治疗,单纯幕下入路38例,单纯幕上入路19例,幕上幕下联合手术7例。手术切除的64例患者中,SimpsonⅠ级和Ⅱ级56例,Ⅳ级8例。无手术死亡的病例。结论根据肿瘤的位置、大小及生长方向选择手术入路。术中尽量避免过度牵拉造成肿瘤周围组织及血管的损伤。此外,立体定向放射外科治疗可作为小脑幕脑膜瘤的补充治疗方案。
Objective This article analyzes and discusses the 64 cases of cerebellar meningioma, the classification, surgical approach and methods. Methods This article summarizes the surgical treatment of 64 cases of cerebellar meningioma (female 39, male 25) from 1990 to 2006. Patients aged 19 to 73 years (mean 43 years old). The clinical manifestations were headache (38 cases), ataxia (33 cases), dizziness (28 cases), hearing loss / tinnitus (15 cases), epilepsy (8 cases) and cranial nerve damage (29 cases). Meningioma is divided into three types: type I (supratentorial): the tumor main body located in the supratentorial 17 cases; type Ⅱ (supratentorial): the main tumor located in the screen 32 cases; type Ⅲ dumbbell (supratentorial) 15 cases: To the curtain up and down. Among them, according to the development of the main tumor is divided into two subtypes: Ⅲ a type 4 cases: the main tumor located in the screen, to the screen development; Ⅲ b11 cases: the main tumor located in the screen, the curtain to the development. Results All the patients underwent surgical treatment. There were 38 cases of simple submarine approach, 19 cases of simple supratentorial approach and 7 cases of combined surgery under the screen. Of the 64 patients who underwent surgical resection, 56 were Simpson Grade I and Grade II, and 8 were Grade IV. No case of surgical death. Conclusion According to the tumor location, size and direction of choice for surgical approach. Intraoperative as far as possible to avoid excessive traction caused by tumor tissue and blood vessels around the injury. In addition, stereotactic radiosurgery can be used as a supplementary treatment of cerebellar meningiomas.