目的 研究显微外科手术治疗蝶骨嵴脑膜瘤[SRMs)的疗效,探讨手术并发症的原因、处理及预防措施.方法 回顾性分析显微手术治疗SRMs 49例,其中男17例,女32例,平均年龄53.8岁;MRI检查提示内侧型32例,外侧型17例,直径3.8～7.5cm;均采用扩大翼点或颧弓翼点入路,显微手术切除肿瘤.结果 外侧型均全切除,无手术并发症.内侧型全切除25例,大部分切除7例,其中死亡1例,轻残6例,其余均良好.术中并发症包括急性脑膨出3例,颈动脉损伤1例,术中瘤腔内大出血2例;术后并发症有:瘤床内出血4例,硬膜外血肿1例,脑血管痉挛4例,脑梗死3例,术后癫痫1例,意识改变2例,皮下积液4例;预后不良包括肢体功能障碍完全偏瘫3例,乏力或不全偏瘫3例,不全失语1例;动眼神经麻痹4例.结论 良好的显微手术操作技巧,熟悉局部的显微解剖,是提高手术全切除率的前提,正确预测术中可能出现的不同变化,可以减少SRMs手术并发症的发生率;对手术中及手术后出现的各种并发症应采取合适的防治措施.%Objective To assessment the management of complications following microsurgery of sphenoid ridge meningioma and the preventive measures.Methods Forty nine patients with sphenoid ridge meningioma underwent microsurgery from 2003-2009 in our hospital, including 17 males and 32 female with a mean age of 53.8.MRI examination showed wall type in 32 cases and lateral type in 17 with the tumor diameter of 3.8～7.5cm.Microsurgical exairesis was performed with enlarge pterion or arcus jugalis pterion approach.Results All patients with lateral type obtained total resection (TR), and no complication was found.Among patients with wall type, 25 obtained TR and 7 partial resection (PR).In this group 1 patient deceased; the surgical complications included 3 cases of acute encephalocele, 1 carotid artery injury and 2 tumor intracavity hemorrhea; and post-operation complications included 4 cases of secondary tumor intracavity hemorrhea, 1 epidural hematoma (EDH), 4 cerebral angio spasm, 3 cerebral infarction (Cl), 1 epilepsy, 2 consciousness alteration and 4 hypodermic fluidify.The outcomes: 3 patients had limbs disturbance and complete hemiplegia, 3 acratia and partial hemiplegia, 1 partial aphasia and 4 oculomotor paralysis.Conclusion Skillful manipulation and accurate microdissection may increase total resection rate and deduce complications of microsurgery for sphenoid ridge meningioma.
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