[1]雷 鸣 黄书岚.鞍结节脑膜瘤的显微手术治疗[J].中国临床神经外科杂志,2015,(04):201-204.[doi:10.13798/j.issn.1009-153X.2015.04.003]
 LEI Ming,HUANG Shu-lan..Microsurgical treatment of tuberculum sellae meningiomas[J].,2015,(04):201-204.[doi:10.13798/j.issn.1009-153X.2015.04.003]
点击复制

鞍结节脑膜瘤的显微手术治疗()
分享到:

《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
期数:
2015年04期
页码:
201-204
栏目:
论著
出版日期:
2015-04-30

文章信息/Info

Title:
Microsurgical treatment of tuberculum sellae meningiomas
文章编号:
1009-153X(2015)04-0201-04
作者:
雷 鸣 黄书岚
430070 武汉,武汉大学人民医院神经外科(雷 鸣、黄书岚)
Author(s):
LEI Ming HUANG Shu-lan.
Department of Neurosurgery, Renmin Hospital, Wuhan University, Wuhan 430060, China
关键词:
鞍结节脑膜瘤显微手术效果
Keywords:
Tuberculum sellae meningiomas Microsurgery Operative approach Outcome
分类号:
R739.41;R651.1+1
DOI:
10.13798/j.issn.1009-153X.2015.04.003
文献标志码:
A
摘要:
目的 探讨鞍结节脑膜瘤的显微手术治疗方法及其效果。方法 回顾性分析2007年1月至2013年7月显微手术治疗的45例鞍结节脑膜瘤患者的临床治疗,采用单侧额下入路22例,纵裂入路5例,翼点或扩大翼点入路15例,翼点及额下联合入路3例。结果 肿瘤全切除程度:Simpson分级Ⅰ级23例,Ⅱ级14例,Ⅲ级5例,Ⅳ级3例;肿瘤全切除率达82.2%。术前合并不同程度视力障碍的37例患者中,术后视力较术前好转27例,无明显变化6例,恶化4例;视力改善率73.0%。结论 鞍结节脑膜瘤周围毗邻重要结构,显微手术是其的主要治疗方法;手术时应根据肿瘤大小、生长方式、视力受损程度及术者习惯等选择不同的入路;熟悉的显微解剖知识、娴熟的显微外科技巧是手术成功的关键。
Abstract:
Objective To explore the microsurgical technique to treat the tuberculum sellae meningiomas (TSM) and the curative effect of microsurgery on them. Methods The clinical data of 45 patients with TSM, of whom, 22 underwent microsurgery via the unilateral subfrontal approach, 5 via the cerebral longitudinal fissure approach, 15 via pterional or extended pterional approach and 3 via the combined pterional and subfrontal approach from January, 2007 to July, 2013, were analyzed retrospectively. Results Simpson grade Ⅰ resection of the tumors was achieved in 23 patients, grade Ⅱ in 14, grade Ⅲ in 5 and grade Ⅳ in 3. The rate of gross total resection was 82.3% (37/45). Of 37 patients with disturbances of visual acuity and/or visual field before the operation, 27 (73.0%) were improved, 5 unchanged and 4 worsened. No patients died after the operation. Conclusions The main method to treat TSM is microsurgery. The choice of surgical approach should be based on the tumor size, growth pattern of tumor, degree of visual disturbance and experience of surgeon in the patients with TSM. Understanding the microanatomy related to the saddle area and skillful microsurgical techniques are key to the good curative effect of microsurgery on TSM.

参考文献/References:

[1] Bowers CA, Altay T, Couldwell WT. Surgical decision- making strategies in tuberculum sellae meningioma resec- tion [J]. Neurosurg Focus, 2011, 30(5): E1.
[2] de Divitiis E, Esposito F, Cappabianca P, et al. Tuberculum sellae meningiomas: high route or low route: a series of 51 consecutive cases [J]? Neurosurgery, 2008, 62(3): 556-563.
[3] 肖 泉,梁有明,蓝胜勇,等. 经额外侧入路手术治疗鞍结 节脑膜瘤[J]. 中国临床神经外科杂志,2013,18(9):563- 565.
[4] Landeiro JA, Gon?alves MB, Guimar?es RD, et al. Tubercu- lum sellae meningiomas: surgical considerations [J]. Arq Neuropsiquiatr, 2010, 68(3): 424-429.
[5] Wang H, Sun W, Fu Z, et al. The pattern of visual impair- ment in patients with pituitary adenoma [J]. J Int Med Res, 2008, 36(5): 1064-1069.
[6] George U, Vallo B. Tubereuium sellae meningioma: micro- surgical anatomy and surgical technique [J]. J Neurosurg, 2002, 51: 1432-1439.
[7] 洪正安,牛朝诗. 鞍结节脑膜瘤显微外科手术入路选择与 临床分析[J]. 立体定向和功能性神经外科杂志,2012, 25:20-25.
[8] 秦 汉,龚 杰,张 戈,等. 鞍结节脑膜瘤的影像学特征 及翼点锁孔手术治疗[J]. 中国临床神经外科杂志,2014, 19:641-644.
[9] Margalit N, Shahar T, Barkay G, et al. Tuberculum sellae meningiomas: surgical technique, visual outcome, and prog- nostic factors in 51 cases [J]. J Neurol Surg B Skull Base, 2013, 74(4): 247-258.
[10] Fahlbusch R, Schott W. Pterional surgery of meningiomas of the tuberculum sellae and planum sphenoidale: surgical results with special considerations of ophthalmological and endocrinological outcomes [J]. J Neurosurg, 2002, 96: 235- 243.
[11] Jallo GI, Benjamin V. Tuberculum sellae meningiomas: microsurgical anatomy and surgical technique [J]. Neuro- surgery, 2002, 51: 1432-1440.
[12] Nakamura M, Roser F, Struck M, et al. Tuberculum sellae meningiomas: clinical outcome considering different surgi- cal approaches [J]. Neurosurgery, 2006, 59: 1019-1029.
[13] Panigrahi MK. Suprasellar meningiomas [J]. Neurosurgery, 2004, 50: 1403-1404.
[14] Palani A, Panigrahi MK, Purohit AK. Tuberculum sellae meningiomas: a series of 41 cases; surgical and ophthalmo- logical outcomes with proposal of a new prognostic scoring system [J]. J Neurosci Rural Pract, 2012, 3(3): 286-293.
[15] Goel A, Muzumdar D, Desai KI. Tuberculum sellae menin- gioma: a report on management on the basis of a surgical experience with 70 patients [J]. Neurosurgery, 2002, 51: 1358-1363.
[16] Margalit N, Kesler A, Ezer H, et al. Tuberculum and dia- phragma sella meningioma--surgical technique and visual outcome in a series of 20 cases operated over a 2.5-year period [J]. Acta Neurochir (Wien), 2007, 149: 1199-1204.
[17] Park CK, Jung HW, Yang SY, et al. Surgical treated tuber- culum sellae and diaphragm sellae meningiomas: the importance of short-term visual outcome [J]. Neurosurgery, 2006, 59: 238-243.
[18] Pamir MN, Ozduman K, Belirgen M, et al. Outcome deterr- ninants of pterional surgery for tuberculum sellae menin- giomas [J]. Acta Neurochir (Wien), 2005, 147: 1121-1130.
[19] Park CK, Jung HW, Yang SY, et al. Surgically treated tuberculum sellae and diaphragm sellae meningiomas: the importance of short-term visual outcome [J]. Neurosurgery, 2006, 59: 238-243.

相似文献/References:

[1]林国中 王振宇 马长城 赵 薇.神经电生理监测下显微手术切除脊髓髓内肿瘤[J].中国临床神经外科杂志,2015,(11):647.[doi:10.13798/j.issn.1009-153X.2015.11.003]
 LIN Guo-zhong,WANG Zhen-yu,MA Chang-cheng,et al.Clinical value of intraoperative electrophysiological monitoring to microsurgery for intramedullary spinal tumors[J].,2015,(04):647.[doi:10.13798/j.issn.1009-153X.2015.11.003]
[2]谢京城 王振宇 陈晓东.骶管终丝脊膜囊肿合并脊髓拴系综合征的诊断和治疗[J].中国临床神经外科杂志,2015,(11):651.[doi:10.13798/j.issn.1009-153X.2015.11.004]
 XIE Jing-cheng,WANG Zhen-yu,CHEN Xiao-dong.Diagnosis and surgical treatment of sacral spinal meningeal cysts of fila terminale complicated with tethered spinal cord syndrome[J].,2015,(04):651.[doi:10.13798/j.issn.1009-153X.2015.11.004]
[3]于 涛 黄正通 王振宇.椎管内脊膜囊肿的临床特征和治疗方法[J].中国临床神经外科杂志,2015,(11):654.[doi:10.13798/j.issn.1009-153X.2015.11.005]
 YU Tao,HUANG Zheng-tong,WANG Zhen-yu.Clinical features and treatment of intraspinal arachnoid cysts[J].,2015,(04):654.[doi:10.13798/j.issn.1009-153X.2015.11.005]
[4]谢宝树 王 宇 贾 锋 张 林 殷玉华.神经电生理监测下显微手术治疗成人脊髓栓系综合征[J].中国临床神经外科杂志,2015,(11):658.[doi:10.13798/j.issn.1009-153X.2015.11.006]
 XIE Bao-shu,WANG Yu,JIA Feng,et al.Intraoperative electrophysiological monitoring-guided microsurgery on tethered spinal cord syndrome in adults[J].,2015,(04):658.[doi:10.13798/j.issn.1009-153X.2015.11.006]
[5]赵东升 王正君 孙刚锋 费 舟 姬西团 李 娟 万晓强.椎管内畸胎瘤的诊断与治疗[J].中国临床神经外科杂志,2015,(11):661.[doi:10.13798/j.issn.1009-153X.2015.11.007]
 ZHAO Dong-sheng,WANG Zheng-jun,SUN Gang-feng,et al.Dignosis and treatment of intraspainal teratomas[J].,2015,(04):661.[doi:10.13798/j.issn.1009-153X.2015.11.007]
[6]陈晓东 于 涛 王振宇.脊髓髓内神经鞘瘤的诊断与治疗[J].中国临床神经外科杂志,2015,(11):670.[doi:10.13798/j.issn.1009-153X.2015.11.010]
 CHEN Xiao-dong,YU Tao,WANG Zhen-yu.Diagnosis and treatment of intramedullary spinal schwannomas[J].,2015,(04):670.[doi:10.13798/j.issn.1009-153X.2015.11.010]
[7]马 磊 张海红 张 威 衡立君 孙树凯 贾 栋.眶上锁孔入路手术切除前颅底脑膜瘤的临床效果[J].中国临床神经外科杂志,2015,(11):680.[doi:10.13798/j.issn.1009-153X.2015.11.013]
 MA Lei,ZHANG Hai-hong,ZHANG Wei,et al.Microsurgery through supraorbital keyhole approach for anterior cranial fossa meningiomas[J].,2015,(04):680.[doi:10.13798/j.issn.1009-153X.2015.11.013]
[8]李春坡 郑 军 李海元 边 涛 韩安国.侧脑室三角区小型脑膜瘤的显微外科治疗[J].中国临床神经外科杂志,2015,(11):694.[doi:10.13798/j.issn.1009-153X.2015.11.018]
[9]张兆斯 但 炜 王 刚 周 超 孙 超 谢延风 石全红 詹 彦.咪达唑仑和丙泊酚诱导麻醉对继发性癫痫术中皮层脑电图的影响[J].中国临床神经外科杂志,2016,(05):261.[doi:10.13798/j.issn.1009-153X.2016.05.002]
 ZHANG Zhao-si,DAN Wei,WANG Gang,et al.Effects of midazolam or propofol used for induction of anesthesia on intraoperative ECoG in patients with secondary epilepsy[J].,2016,(04):261.[doi:10.13798/j.issn.1009-153X.2016.05.002]
[10]赵 平 王雄伟 汪 雷 马金阳.显微手术和血管内栓塞术治疗颅内动脉瘤的疗效分析[J].中国临床神经外科杂志,2016,(05):281.[doi:10.13798/j.issn.1009-153X.2016.05.008]
 ZHAO Ping,WANG Xiong-wei,WANG Lei,et al.Effect of endovascular treatment on intracranial aneurysms: a comparison with microsurgery[J].,2016,(04):281.[doi:10.13798/j.issn.1009-153X.2016.05.008]
[11]黄进兴 叶 敏 李劲松 胡 威 刘广普 谢成金.27例鞍结节脑膜瘤的显微手术体会[J].中国临床神经外科杂志,2017,(06):422.[doi:10.13798/j.issn.1009-153X.2017.06.019]
[12]左德献,李正阳,吾太华,等.鞍结节脑膜瘤的显微手术治疗[J].中国临床神经外科杂志,2019,(06):327.[doi:10.13798/j.issn.1009-153X.2019.06.003]
 ZUO De-xian,LI Zheng-yang,WU Tai-hua,et al.Microsurgery for tuberculum sellea meningiomas (report of 46 cases)[J].,2019,(04):327.[doi:10.13798/j.issn.1009-153X.2019.06.003]

备注/Memo

备注/Memo:
通讯作者:黄书岚,E-mail:huang_shulan@msn.com
更新日期/Last Update: 2016-04-25