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目的探讨鞍结节脑膜瘤的手术入路和手术技巧,以改善手术治疗的效果。方法回顾性分析1985年1月至2004年12月手术治疗的鞍结节脑膜瘤47例,根据CT和MRI的表现,将其分为大、中、小三型,采用4种不同的手术入路,比较全切除率、手术结果和并发症发生情况。结果47例肿瘤中,获全切除44例,次全切除3例。肿瘤的全切除率与肿瘤大小和手术入路无关(P>0.05)。手术后恢复良好者43例;中度致残2例;重残1例;死亡1例,死亡率2.1%。手术结果与肿瘤大小和手术入路无关(P>0.05)。结论大多数鞍结节脑膜瘤可以完全及安全地切除,小、中型肿瘤宜采用眶上匙孔入路,中、大型肿瘤宜采用单侧额下或翼点侧裂入路,大型肿瘤或侵犯肿瘤视神经管者宜采用眶颧入路切除肿瘤。不管采用何种入路,切除肿瘤的技术是相同的,也是全切除肿瘤的关键。
Objective To study the surgical approach and surgical technique of saddle nodular meningioma to improve the effect of surgical treatment. Methods Retrospective analysis of surgical treatment of saddle nodular meningioma from January 1985 to December 2004 47 cases, according to CT and MRI performance, it is divided into large, medium and small three types, using four different surgical approaches , More total resection rate, surgical results and complications. Results 47 cases of tumors, the total resection in 44 cases, subtotal resection in 3 cases. Tumor resection rate and tumor size and surgical approach has nothing to do (P> 0.05). 43 cases recovered well after surgery; 2 cases of moderate disability; 1 case of severe disability; 1 case died and the mortality rate was 2.1%. The result of surgery was not related to tumor size and surgical approach (P> 0.05). Conclusions Most of saddle nodular meningiomas can be completely and safely removed. Small and medium tumors should be treated with supraorbital keyhole approach. Medium and large tumors should be unilateral or pterional fissures, large tumors or violations Optic neural tube tumors should adopt the orbital zygomatic approach to remove the tumor. Regardless of the approach taken, the technique of resecting the tumor is the same and is the key to total removal of the tumor.