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目的:探讨中央沟区脑膜瘤显微手术切除技巧及疗效分析。方法:回顾性分析我院神经外科经显微手术切除的20例中央沟区脑膜瘤的临床资料、治疗效果及预后情况。结果:20例患者均在显微镜下行肿瘤切除,术中中央沟静脉、中央区皮质、上矢状窦等保护完好,其中SimponⅠ级切除11例,SimponⅡ级切除9例,无手术死亡病例。其中1例合并一侧幕上慢性硬膜下血肿,3例合并脑梗死。术后新发生暂时性肢体肌力下降、肌力障碍加重各1例,均于术后1个月内恢复。随访6~12个月,术前已有感觉障碍的3例,均于术后3个月内恢复;术前已有肌力障碍的6例患者均于术后6个月内完全恢复;术前有癫痫的2例患者,术后经系统、正规抗癫痫治疗,均无癫痫发作;无肿瘤复发病例。结论:精细的显微手术切除中央沟区脑膜瘤,术中保护好中央沟静脉、中央沟区皮质及上矢状窦,不仅可以提高肿瘤全切率,更能最大程度保护患者神经功能,提高手术疗效。
Objective: To investigate the microsurgical techniques and curative effects of meningioma in central ditch area. Methods: The clinical data, therapeutic effects and prognosis of 20 cases of meningioma in central sulcus were retrospectively analyzed. Results: Twenty patients underwent microsurgical resection of the tumor. There were 11 cases with Simpon Ⅰ grade resection, 9 cases with Simpon Ⅱ grade resection and no case of surgical death in the central ditch vein, central cortex and superior sagittal sinus. One case complicated with chronic supratentorial subdural hematoma on one side and 3 cases complicated by cerebral infarction. One new case of temporary limb muscle loss and muscular dysfunction occurred in each case, all of which recovered within 1 month after operation. All patients were followed up for 6 ~ 12 months. Three patients had preoperative sensory dysfunction, all of them recovered within 3 months after surgery. Six patients with preoperative muscle weakness were completely recovered within 6 months after operation. Two patients with pre-epilepsy, postoperative systemic, regular antiepileptic treatment, no seizures; no tumor recurrence. Conclusion: Fine microsurgical resection of meningioma in central ditch area can protect the central ditch veins, cortex of central ditch and superior sagittal sinus. It not only improves the rate of tumor resection, but also protects the neurological function of patients to the greatest extent Surgical efficacy.