【作者】 高峰； 杨乐； 麦麦提伊明·托合提； 董军； 帕热哈提江·依孜木； 孙连杰； 吴永刚； 杨小朋； Zhang Cheng；

【Author】 Gao Feng;Mai Mai Ti Yi Ming tuo he ti;Dong Jun;Pareha Ti Jiang yi zi mu;Sun Lianjie;Zhang Cheng;Wu Yonggang;Yang Xiaopeng;People’s Hospital of Xinjiang Uygur Autonomous Region Neurosurgery;

【机构】 新疆维吾尔自治区人民医院神经外科； People’s Hospital of Xinjiang Uygur Autonomous Region Neurosurgery；

【摘要】 目的探讨经单侧额下入路显微手术切除嗅沟脑膜瘤的临床效果及其手术安全性。方法对新疆维吾尔自治区人民医院神经外科2015年2月至2019年6月实施单侧额下入路显微切除嗅沟脑膜瘤35例患者的临床资料进行回顾性分析。根据患者影像学检查结果分析手术切除程度、组织学类型和术后并发症情况。结果本组35例患者术前磁共振成像(MRI)检查确定的最大肿瘤直径在3.2-5.5cm之间,平均4.5cm。平均发病年龄为49岁(年龄:30-70岁),性别比为2.2:1(女性:男性)。SimpsonⅠ级切除28例(80%),SimpsonⅡ级切除7例(20%),皮细胞型28例(80%)、非典型3例(8.6%)、纤维型2例(5.7%)、过渡细胞型,混合型各1例。术后无死亡患者,嗅觉缺失12例(35%),嗅觉减退13例(37%),新发癫痫3例,经药物治疗后好转,无因额窦开放脑脊液漏患者,头痛、视力下降、精神症状术后明显改善,2例患者因切除困难1月后行伽玛刀辅助治疗,所有患者随访期内无肿瘤复发。结论经单侧额下入路可直接从肿瘤前方显露基底部,无额叶牵拉损伤,符合微创外科的治疗理念,临床效果确切,并发症低,显著改善患者的临床症状,提高了患者术后的生活质量。更多还原

【Abstract】 Objective To investigate the efficacy and safety of surgical treatment for olfactory groove meningiomas via a unilateral subfrontal approach.Methods Between February 2015 and June 2019,35 patients with olfactory groove meningiomas underwent surgery through unilateral subfrontal opproach at department of neurosurgey,People ’ s Hospital of Xinjiang Uygur Autonomous Region.Their clinical date,surgical treatment and outcomes were analyzed retrospectively.The degree of surgical resection,histological type and postoperative complications were analyzed based on the results of the patient’s imaging examination.Results The largest tumor diameter determined by preoperative magnetic resonance imaging(MRI) in this group of 35 patients was between 3.2-5.5cm,with an average of 4.5cm.The average age of onset is 49 years(age:30-70 years),and the sex ratio is 2.2:1(female:male).The tumor resection was Simpson grade I in 28 cases(80%)、Simpson gradeⅡin 7 cases(20%),28 cases of Meningothelial type(80%),3 cases of atypical type(8.6%),2 cases of fibrous type(5.7%),transitional cell type,1 case of mixed type.There was no death.There were 12 cases of anosmia(35%),13 cases of hyposmia(37%),and 3 cases of new epilepsy,which were improved after drug treatment.There were no patients with cerebrospinal fluid leakage due to frontal sinus opening,and their headache,vision loss and mental symptoms were significantly improved after surgery.2 patients underwent gamma knife assisted therapy 1 month later due to resection difficulty,All patients had no tumor recurrence during the follow-up period.Conclusion The unilateral subfrontal approach can expose the basal part directly from the front of the tumor,without frontal lobe traction injury.It is in line with the treatment concept of minimally invasive surgery.The clinical effect is accurate,the complications are low,the clinical symptoms of the patient are significantly improved,and improve the quality of life of patients after surgery.更多还原