【摘要】 目的 探讨经翼点入路切除前床突脑膜瘤的临床疗效，并分析影响手术疗效的相关因素。方法 回顾分析选取2008年10月至2021年12月在四川友谊医院行手术治疗90例前床突脑膜瘤患者，均经翼点入路切除肿瘤。记录手术切除程度，术后并发症情况、术后复发/进展情况，并分析术后复发/进展的影响因素。结果 SimpsonⅠ～Ⅱ级切除73例(81.11%),Ⅲ级切除12例(13.33%),Ⅳ级切除5例(5.56%)。术后并发症以动眼神经麻痹的发生率最高，为17.78%,其次分别为偏瘫(8.79%)、视力恶化(3.33%)、面神经额支损伤(2.22%)、颅内感染(2.22%)、脑脊液漏(1.11%)、肺部感染(1.11%)、脑水肿加重(1.11%)、硬膜外血肿(2.22%)。与入院时相比，患者出院时的Karnofsky功能状态评分标准(KPS)评分均明显提高，随访期间，患者的神经功能恢复良好，日常生活、工作基本恢复正常，KPS评分优良率为100.00%。随访时，患者的KPS评分优良率明显高于入院时(57.78%)和出院时(81.11%),差异均有统计学意义(P<0.05)。术后共9例复发或发生进展，复发组与未复发组患者的性别、年龄、肿瘤与颈内动脉关系、肿瘤质地及肿瘤钙化情况比较，差异均无统计学意义(P>0.05)。与未复发组相比，复发组患者的侵袭海绵窦占比、肿瘤最大径大于4 cm占比、骨质破坏占比、肿瘤切除SimponnⅢ～Ⅳ级占比均明显更高，WHO病理分级1级者占比明显更低，差异均有统计学意义(P<0.05)。结论 根据前床突脑膜瘤患者术前的影像学特征选取经翼点入路切除术可获得良好的远期疗效，肿瘤病理分级、侵犯海绵窦、肿瘤大小、颅底骨质破坏是术后复发的影响因素。更多还原

【Abstract】 Objective To explore the clinical efficacy of excision of anterior clinoid meningioma via pterional approach, and analyze the related factors affecting the surgical effect.Methods A total of 90 patients with anterior clinoid meningiomas who removed the tumors via pterional approach in the Sichuan Friendship Hospital from October 2008 to December 2021.The degree of resection, postoperative complications, postoperative recurrence/progression were recorded, and the influencing factors of postoperative recurrence/progression were analyzed.Results There were 73 patients(81.11%) underwent Simpson′s level Ⅰ-Ⅱ resection, 12 patients(13.33%) underwent level Ⅲ resection, five patients(5.56%) underwent level Ⅳ resection.The highest incidence of postoperative complications was oculomotor nerve palsy(17.78%),followed by hemiplegia(8.79%),visual deterioration(3.33%),and frontal branch injury of facial nerve(2.22%),intracranial infection(2.22%),cerebrospinal fluid leakage(1.11%),pulmonary infection(1.11%),aggravation of brain edema(1.11%),and epidural hematoma(2.22%).Compared with admission, the Karnofsky(KPS) scores of patients at discharge were significantly improved.During the follow-up period, the neurological function of patients recovered well, and their daily life and work basically returned to normal.The excellent and good rate of KPS scores was 100.00%.The excellent and good rates of KPS in follow-up were significantly higher than those(57.78%) on admission and(81.11%) at discharge, the differences were statistically significant(P<0.05).A total of 9 patients were experienced postoperative recurrence or progression.There were no significant differences in gender, age, relationship between tumor and internal carotid artery, tumor texture and tumor calcification between the recurrence group and the non recurrence group(P>0.05).Compared with the non recurrence group, the proportion of invasive cavernous sinus, tumor with the largest diameter > 4 cm, bone destruction, Simpon Ⅲ-Ⅳ grade tumor resection in the recurrence group were significantly higher, and the proportion of those with WHO pathologic grade one was significantly lower, with statistically significant differences(P<0.05).Conclusion The long-term effect of excision via pterional approach selected according to the preoperative imaging characteristics of the patients with anterior clinoid meningioma before operation can achieve good results.Pathological grade of tumor, invasion of cavernous sinus, tumor size and destruction of skull base bone are the influencing factors of postoperative recurrence.更多还原