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《临床神经外科杂志》[ISSN:1672-7770/CN:32-1727/R]

卷:

17

期数:

2020年03期

页码:

273-277

栏目:

颅底肿瘤专题

出版日期:

2020-06-15

文章信息/Info

Title:

Clinical characteristics and microsurgical outcomes of ‘middle fossa floor’ meningioma

文章编号:

202003007

作者:

李三中; 王凯; 孙季冬; 林伟; 高大宽; 蒋晓帆; 费舟

710032 西安，空军军医大学第一附属医院神经外科

Author(s):

LI San-zhong;  WANG Kai;  SUN Ji-dong;  et al.

Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xian 710032, China

关键词:

中颅窝底; 脑膜瘤; Simpson分级; 外科手术; 额颞入路; 颅底重建

Keywords:

middle fossa floor;  meningioma Simpson grade surgical intervention;  frontotemporal approach skull base reconstruction

分类号:

R739.41

DOI:

DOI:10.3969/j.issn.1672-7770.2020.03.007

文献标志码:

A

摘要:

目的探讨中颅窝底脑膜瘤的临床特点、手术治疗方法，以及肿瘤切除程度与疗效之间的关系。方法回顾性分析空军军医大学第一附属医院神经外科2016年3月—2019年3月收治的24例中颅窝底脑膜瘤患者的临床资料。患者均行显微镜下肿瘤切除术,取额颞开颅，根据肿瘤暴露的需要进行断颧弓或改良眶颧入路。肿瘤切除程度根据Simpson分级判断。结果本组患者临床表现为头痛者15例、三叉神经功能障碍11例、步态障碍4例、癫痫发作4例。其中达到Simpson Ⅰ/Ⅱ级切除者18例，Simpson Ⅲ级切除者5例，Simpson Ⅳ级切除者1例；无手术死亡患者。术后随访平均2年，2例患者肿瘤复发；其中1例患者为Simpson Ⅳ级切除，复发后再次行手术治疗；另1例患者为Simpson Ⅲ级切除，病理诊断WHO Ⅱ级（不典型脑膜瘤，Ki-67指数15%），再次手术治疗后给予适形分割放疗。结论中颅窝底脑膜瘤手术的入路，在额颞入路的基础上进行断颧弓或改良眶颧入路的个体化设计；尽量行Simpson Ⅰ/Ⅱ级切除。对不能达到Simpson Ⅰ/Ⅱ切除、非典型或间变性脑膜瘤患者，可早期行适形分割放疗，以防肿瘤复发。

Abstract:

Objective To study clinical characteristics, highlights of microsurgery and relationship between the degree of tumor resection and the curative effect in patients presenting with meningiomas arising from floor of the middle cranial fossa. Methods The clinical data of 24 patients were diagnosed as meningioma arising from the base of middle cranial fossa in department of Neurosurgery, the First Affiliated Hospital of Air Force Military Medical University from 2016 and 2019 were analyzed respectively. All patients underwent microsurgery through frontotemporal approach, zygomatic arch cut off or orbital zygomatic approach modified were performed according to the needs of tumor exposure. The degree of tumor resection was judged according to Simpsons classification. Results The clinical manifestations of this group were headache in 15 cases, trigeminal nerve dysfunction in 11 cases, gait disturbance in 4 cases and epilepsy in 4 cases. Among the 24 patients, 18 patients accepted Simpson grade Ⅰ to Ⅱ resection, 5 patients accepted Simpson grade Ⅲ resection, 1 patients accepted Simpson grade Ⅳ resection, and no surgical morbidity happened. 2 median years follow-up indicated 2 clinical recurrences. One patient received Simpson Ⅳ grade resection and was operated again after recurrence. The other patient received Simpson Ⅲ grade resection, the pathological diagnosis was atypical meningioma(WHO grade Ⅱ, Ki-67 index 15%) and was treated with conformal fractionated radiotherapy after surgical resection again. Conclusions On the basis of frontotemporal approach, zygomatic arch cut off or orbital zygomatic approach modified are performed according to the needs of tumor exposure. For patients who cant be resected to the extent of Simpson Ⅰ to Ⅱ, or those diagnosed as atypical or anaplastic meningiomas pathologically, conformal fractionated radiotherapy can be performed early to prevent tumor recurrence.

备注/Memo

备注/Memo:

作者简介：李三中，空军军医大学西京医院神经外科医学博士，副主任医师、副教授、硕士研究生导师。主要从事颅底肿瘤（包括内镜颅底外科）的手术治疗，听神经瘤的手术治疗，面瘫的综合治疗。临床工作15年来，长期从事颅底神经外科相关领域疾病的诊疗工作，熟练掌握颅底解剖学知识及显微神经外科技术，坚持将微创理念贯穿患者诊治的全过程。擅长颅内各种复杂肿瘤（以颅底肿瘤为主）的微创手术治疗，如脑膜瘤、听神经瘤、垂体瘤、胶质瘤、颅咽管瘤、颈静脉孔区肿瘤、海绵窦区肿瘤、海绵状血管瘤、脊索瘤、转移瘤等疾病的微创手术治疗。尤其与美国颅底外科的专家（Johnshopkins、Texas、Barrow、UPMC）经常进行深入交流，将国外的先进理念应用于患者的诊治过程中。在经典颅底外科手术入路治疗颅底复杂肿瘤方面做了大量的工作，如采用额眶颧入路切除巨大蝶岩脑膜瘤和海绵窦肿瘤、Kawase入路切除岩斜区脑膜瘤、功能性经岩骨入路切除岩斜区肿瘤、远外侧入路切除延髓腹侧病变、扩大中颅窝入路切除侵犯岩骨肿瘤如神经鞘瘤，从安全区入路切除脑干胶质瘤和脑干海绵状血管瘤等。科研方面：神经系统肿瘤的恶性生物学行为的机制及临床研究。负责国科金青年项目1项，参与军委科技委子课题一项，陕西省青年自然科学基金1项，西京医院后备人才资助计划1项，西京新技术新业务1项，第一参与人参与西京医院新技术新业务一项（面-舌下神经吻合术治疗面神经损伤所致周围性面瘫）；参与国家自然科学基金4项、国家自然科学青年基金2项，总经费1000余万元。参编、参译专注各一部。以第一、共一或通讯作者发表SCI文章20余篇，国内核心期刊数篇。担任以下学术任职：中国研究型医院协会神经外科分会，青年委员；陕西省抗癌协会肿瘤综合治疗委员会青年委员会，常委，陕西省抗癌协会神经肿瘤专业委员会青年委员会，委员。

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更新日期/Last Update: 2020-06-17