[1]陈政纲　杨　堃　王子珍　周　建　吴　然　叶富跃　邢　伟.中央区巨大脑膜瘤的显微手术治疗[J].中国临床神经外科杂志,2019,(08):464-466.[doi:10.13798/j.issn.1009-153X.2019.08.005]
　CHEN Zheng-gang,YANG Kun,WANG Zi-zheng,et al.Microsurgical treatment for giant meningiomas in the central gyrus region[J].,2019,(08):464-466.[doi:10.13798/j.issn.1009-153X.2019.08.005]
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中央区巨大脑膜瘤的显微手术治疗()
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《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
期数:
2019年08期
页码:
464-466
栏目:
论著
出版日期:
2019-08-25

文章信息/Info

Title:
Microsurgical treatment for giant meningiomas in the central gyrus region
文章编号:
1009-153X（2019）08-0464-03
作者:
陈政纲　杨　堃　王子珍　周　建　吴　然　叶富跃　邢　伟
570102 海口，海南医学院第一附属医院神经外科（陈政纲、杨　堃、王子珍、周　建、吴　然、叶富跃、邢　伟）
Author(s):
CHEN Zheng-gang;  YANG Kun;  WANG Zi-zheng;  ZHOU Jian;  WU Ran;  YE Fu-yue;  CING Wei.
Department of Neurosurgery, The First Affiliated Hospital of Hainan Medical University, Haikou 570102, China
关键词:
脑膜瘤; 中央区; 手术治疗; 围手术期管理
Keywords:
Meningioma;  Central gyrus region;  Surgical treatment;  Perioperative management
分类号:
R 739.41; R 651.1+1
DOI:
10.13798/j.issn.1009-153X.2019.08.005
文献标志码:
A
摘要:
目的 探讨中央区巨大脑膜瘤的围手术期管理及手术注意事项。方法 回顾性分析2008年1月至2016年1月收治的18例中央沟区巨大脑膜瘤的临床资料，总结手术治疗经验。结果 18例中，Simpson分级Ｉ级切除13例，Ⅱ级切除3例，Ⅲ级切除2例。术后出现肢体肌力下降8例，癫痫发作6例，脑水肿加重行去骨瓣减压术1例。术后随访1年，肢体肌力恢复正常16例，下肢肌力Ⅳ级1例，长期昏迷1例；无癫痫发作病例。术后3年复发1例，术后5年复发1例。结论 对于中央区巨大脑膜瘤，术前需仔细评估，充分了解肿瘤的血供、性质、静脉引流情况，必要时行DSA检查及栓塞部分供血动脉；术中通过合适的暴露范围，留置腰大池引流管引流脑脊液，减少脑组织牵拉，分块切除肿瘤，保护引流静脉，争取全切肿瘤；术后合理地预防癫痫，维持血压稳定，尽早进行康复治疗，减少并发症，提高治疗效果。
Abstract:
Objective To explore the perioperative managements and surgical considerations of giant meningioma in the central gyrus region. Methods The clinical data of 18 patients with giant meningioma in the central gyrus region who underwent microsurgery from January 2008 to January 2016 were analyzed retrospectively. The experience of surgical treatment was summarized. Results Of 18 patients, Simpson grade I resection was performed in 13 patients, grade II resection in 3 and grade III resection in 2. The decraese in postoperative limb muscle strength occurred in 8 patients, postoperative epileptic seizures occurred in 6, and aggravation of cerebral edema occurred in 1 who underwent decompressive craniectomy. The results of 1 year follow-up showed that limb muscle strength returned to normal in 16 aptients, grade IV in 1, and long-term coma in 1. There was no epileptic seizures 1 year after the operation. The recurrence of tumor occurred in 1 patient 3 years and in 1 patient 5 years after the operation. Conclusions For microsurgical treatment of giant meningioma in the central gyrus region, the blood supply, nature and venous drainage of the tumors should be carefully evaluated before the operation; the DSA examination and embolism of partial blood supply artery should be performed when necessary; the cerebrospinal fluid should be drained by indwelling lumbar cistern drainage tube during the operation; the brain tissue traction should be reduced; the tumors should be resected in blocks; the drainage veins should be protected and the total rection of tumor should be made as far as possible. The measures including reasonable prevention of seizures, maintenance of blood pressure stability, and early rehabilitation treatment are helpful to the reduction of complications and improvement of treatment effect.

参考文献/References:

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备注/Memo

备注/Memo:
（2019-07-25收稿，2019-08-05修回）
更新日期/Last Update: 2019-08-25