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首页> 外文期刊>Neurosurgery >Cranial base surgical techniques for large sphenocavernous meningiomas: technical note.
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Cranial base surgical techniques for large sphenocavernous meningiomas: technical note.

机译：大型蝶腔脑膜瘤的颅底手术技术：技术说明。

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OBJECTIVE: Large meningiomas arising from the dura covering the sphenoid ridge present surgical challenges because of frequent involvement of the carotid artery and its branches, the optic nerve and tract, the superior orbital fissure, and cavernous sinus structures. To circumvent the inherent difficulties of a traditional approach strategy, cranial base approaches were applied to: 1) isolate and interrupt the major blood supply as an initial step, 2) minimize brain retraction, and 3) isolate the neurovascular structures exiting the tumor at the cranial base to protect and better separate them. METHODS: Six patients were treated with such a strategy in the past 2 years (five women and one man, ages 34-69 yr). All tumors measured at least 5 cm in their greatest diameter and arose at the sphenoid ridge. All tumors extended posteriorly to involve the cavernous sinus to varying degrees. In two patients a frontotemporal bone flap was used; in two patients, a transzygomatic approach was used; and in the remaining two patients, an orbitozygomatic strategy was used. Extensive bone removal at the cranial base was performed in all cases. RESULTS: Four patients had gross total resections, and two were subtotal owing to invasion of the cavernous sinus or the middle cerebral artery. There were no permanent cranial nerve deficits; however, two patients sustained transient IIIrd nerve paresis. Two patients postoperatively developed transient cerebral edema that required intensive treatment. All six patients had good outcomes, resuming independent activity by 3 months after surgery. CONCLUSION: Contemporary cranial base surgical techniques have a role in the treatment of large sphenoid ridge meningiomas. These strategies result in safe resection with low morbidity and obviate the need in most cases for preoperative embolization. The anatomic foundation for using these approaches is discussed.
机译：目的：硬脑膜覆盖蝶骨ridge引起的大脑膜瘤，由于颈动脉及其分支，视神经和导管，眶上裂和海绵窦结构的频繁介入而引起手术挑战。为了避免传统方法的固有困难，将颅底方法应用于：1）作为初始步骤分离并中断主要的血液供应; 2）最小化大脑的回缩; 3）分离在肿瘤处离开肿瘤的神经血管结构。保护和更好地分离它们的颅底。方法：在过去2年中，有6例患者接受了这种策略的治疗（5名女性和1名男性，年龄34-69岁）。所有肿瘤的最大直径至少为5 cm，并出现在蝶骨ridge处。所有肿瘤均向后扩展，以不同程度累及海绵窦。两名患者使用额颞骨瓣;在两名患者中，采用了转zy入方法。在其余两名患者中，采用了眶y策略。在所有情况下均进行了颅底广泛的除骨。结果：4例患者全部切除，其中2例由于海绵窦或大脑中动脉的侵犯而全部切除。没有永久性颅神经缺损。但是，两名患者持续出现短暂的Ⅲrd神经麻痹。两名患者术后出现短暂性脑水肿，需要加强治疗。所有6例患者均具有良好的预后，术后3个月恢复独立活动。结论：当代颅底手术技术在大蝶骨脊膜脑膜瘤的治疗中具有重要作用。这些策略可实现低发病率的安全切除，并且在大多数情况下无需术前栓塞。讨论了使用这些方法的解剖基础。

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