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背景与目的:颅底脑膜瘤手术难度大,本文总结157例颅底脑膜瘤的临床资料、影像表现和外科手术经验,探讨手术技巧与疗效。方法:我科自1990年1月至2005年5月手术治疗并经病理证实为颅底脑膜瘤者157例,最常见的症状为头痛,共92例(58.6%);其次为视力障碍,共53例,占33.8%。术前所有的患者均行CT和/或MRI检查,部分行脑血管造影检查。根据肿瘤的部位、大小和生长方式采用相应的手术入路,妥善处理肿瘤与血管、神经、静脉窦及脑干的关系,切除肿瘤。结果:87例达到肉眼全切,全切率为55.4%;次全切除57例,占36.3%;活检者13例,占8.3%。未全切的病例均进行放射外科治疗。最常见的并发症为术后神经功能障碍加重,本组病例中38例(24.2%),其中61%为一过性的,永久性的神经功能损伤占39%;术后脑脊液漏次之,为11例,占本组病例的7%;术后术区或远隔部位血肿病例8例(5.1%);新发癫痫和颅内感染各6例,占3.8%。本组病例中死亡6例(3.8%),其中因术后继发出血死亡3例,占死亡中的50%;其它原因死亡3例。结论:颅底脑膜瘤的最佳治疗方式仍为彻底手术切除,但存在一定的风险和死亡率,合理选择手术入路及显微神经外科技术对提高颅底脑膜瘤手术成功率具有重要的作用。
BACKGROUND & OBJECTIVE: Skull base meningioma is difficult to operate. This article summarizes the clinical data, imaging findings and surgical experience of 157 cases of skull base meningiomas. Methods: From January 1990 to May 2005, our department was treated by operation and pathologically confirmed 157 cases of skull base meningioma, the most common symptom was headache, a total of 92 cases (58.6%); followed by visual impairment, a total of 53 cases, accounting for 33.8%. All patients underwent CT and / or MRI preoperatively, and some had cerebral angiography. According to the tumor site, size and growth mode using the appropriate surgical approach to properly handle the tumor and blood vessels, nerves, sinus and brain stem relationship, removal of the tumor. Results: The total resection rate was 55.4% in 87 cases, totally subtotal resection in 57 cases (36.3%) and biopsy in 13 cases (8.3%). Radical surgery was not performed in all cases. The most common complications were postoperative neurological dysfunction aggravated, 38 cases (24.2%) in this group, of which 61% were transient, permanent neurological damage accounted for 39%; followed by cerebrospinal fluid leakage, (11%), accounting for 7% of the patients in this group. There were 8 cases (5.1%) of hematoma in the operation area or remote site after surgery, 6 cases were new-onset epilepsy and intracranial infection, accounting for 3.8%. In this group of patients died in 6 cases (3.8%), of which 3 cases of postoperative bleeding due to death, accounting for 50% of deaths; other causes of death in 3 cases. Conclusion: The best treatment for skull base meningiomas is still complete surgical resection, but there is a certain risk and mortality, reasonable choice of surgical approach and microsurgical neurosurgery technology to improve the success rate of skull base meningioma surgery plays an important role .