显微手术辅助γ刀治疗鞍区大型脑膜瘤的临床效果和安全性评价

doi:10.13481/j.1671-587x.20150630

吉林大学学报(医学版) ›› 2015, Vol. 41 ›› Issue (06): 1255-1259.doi: 10.13481/j.1671-587x.20150630

显微手术辅助γ刀治疗鞍区大型脑膜瘤的临床效果和安全性评价

周辉^1,2, 孙彦龙³, 王志明², 蒲九君², 钟艾凌², 阮伦亮², 靳凯², 耿明英⁴, 杨刚²

1. 重庆市江津区中心医院神经外科, 重庆 402260;
2. 重庆医科大学附属第一医院神经外科, 重庆 400016;
3. 河南省郑州市第一人民医院神经外科, 河南郑州 450004;
4. 第三军医大学大坪医院伽马刀中心, 重庆 400042

收稿日期:2015-03-16 发布日期:2016-01-11
通讯作者: 杨刚,副教授,硕士研究生导师(Tel:023-89011151,E-mail:yg_angcq@163.com) E-mail:yg_angcq@163.com
作者简介:周辉(1983-),男,重庆市人,医师,医学硕士,主要从事神经外科颅底肿瘤方面的研究。
基金资助:
国家临床重点专科建设项目资助课题(财社[2011]170号);重庆市科委自然科学基金资助课题(CSTC2013jcyjA10079)

Clinical effect and safety evaluation of microsurgery associated with Gamma Knife radiosurgery for large meningiomas in sellar region

ZHOU Hui^1,2, SUN Yanlong³, WANG Zhiming², PU Jiujun², ZHONG Ailing², RUAN Lunliang², JIN Kai², GENG Mingying⁴, YANG Gang²

1. Department of Neurosurgery, Jiangjin District Central Hospital, Chongqing 402260, China;
2. Department of Neurosurgery, First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China;
3. Department of Neurosurgery, First People's Hospital of Zhengzhou City, Henan Province, Zhengzhou 450004, China;
4. Gamma Knife Center, Daping Hospital, Third Military Medical University, Chongqing 400042, China

Received:2015-03-16 Published:2016-01-11

摘要/Abstract

摘要：

目的:探讨显微手术切除辅助γ刀治疗鞍区大型脑膜瘤的临床效果和安全性,阐明该方法对鞍区大型脑膜瘤的临床疗效。方法:回顾性分析显微手术治疗的34例鞍区大型脑膜瘤患者的临床资料。所有患者先行显微手术切除肿瘤,有残留的部位术后1个月行γ刀治疗,分析其肿瘤切除情况、并发症、症状缓解率以及复发率。结果:肿瘤全切(SimpsonⅠ级7例,Ⅱ级12例)19例(55.9%)、次全切(Simpson Ⅲ级)14例(41.2%)和大部分切除(Simpson Ⅳ级)1例(2.9%);术后主要并发症有颅神经损伤(动眼、滑车和外展)6例、对侧肢体轻瘫2例、术后出血1例、脑脊液漏伴感染3例和继发性癫痫3例,无手术死亡。随访3~48个月,24例头痛消失(80%),6例减轻(20%);12例视力好转(80%),2例无明显变化(13.3%),1例加重(6.7%);5例嗅觉好转(62.5%),3例无变化(37.5%);5例眼球运动障碍恢复(71.4%),2例无变化(28.6%);7例一侧肢体无力患者术后肌力均恢复正常(100%)。全切患者中1例复发(5.2%),未全切患者均行γ刀治疗,2例复发(13.3%)。结论:显微手术辅助γ刀治疗对鞍区大型脑膜瘤治疗效果良好。

关键词: 鞍区, 大型脑膜瘤, 显微外科手术, γ刀

Abstract:

Objective To investigate the therapeutic effect and safety of microneurosurgery associated with Gamma Knife radiosurgery on the large meningiomas in sellar region,and to clarify its clinical curative effect. Methods The clinical data of 34 patients with large meningiomas in sellar region underwent microsurgery were retrospectively analyzed.All of them underwent microsurgery,and then treated with Gamma Knife radiosurgery in one month after operation if there were residual tumors.The tumor removal of situation,complication,rate of symptom remission,and recurrence rate were analyzed. Results Among the 34 patients,total resection(7 cases of Simpson grade Ⅰ and 12 cases of Simpson grade Ⅱ) was achieved in 19 cases(55.9%),subtotal resection (Simpson grade Ⅲ ) in 14 cases (41.2%),and partial resection (Simpson grade Ⅳ) was achieved in 1 case (2.9%).The major complications were cranial nerve injuries(such as oculomotor nerve,trochlear nerve and abducens nerve,n=6),the contralateral limb paresis(n=2),postoperative bleeding(n=1),CSF leak with infection(n=3),and secondary epilepsy(n=3);no death occurred postoperatively.All these patients were followed up for about 3 to 48 months.Postoperative headache disappeared in 24 cases (80%),and 6 cases were alleviated(20%);postoperative vision improved in 12 cases (80%),remained unchanged in 2 cases(13.3%) and deteriorated in 1 case(6.7%);postoperative olfactory function improved in 5 cases(62.5%) and 3 cases unchanged(37.5%);5 cases recoverd from the ocular motility disorder (71.4%),and 2 cases unchanged(28.6%);7 cases recoverd from thehemiplegia(100%).One of the total resection cases(5.2%) and two of the non-total resection(13.3%) suffered from tumor recurrence.All of the non-total resection cases were treated with Gamma Knife radiosurgery. Conclusion The clinical effect of microneurosurgery associated with Gamma Knife radiosurgery in treatment of large meningiomas in sellar region is satisfactory.

Key words: sellar region, large meningiomas, microsurgery, Gamma Knife radiosurgery

中图分类号:

R739.4

周辉, 孙彦龙, 王志明, 蒲九君, 钟艾凌, 阮伦亮, 靳凯, 耿明英, 杨刚. 显微手术辅助γ刀治疗鞍区大型脑膜瘤的临床效果和安全性评价[J]. 吉林大学学报(医学版), 2015, 41(06): 1255-1259.

ZHOU Hui, SUN Yanlong, WANG Zhiming, PU Jiujun, ZHONG Ailing, RUAN Lunliang, JIN Kai, GENG Mingying, YANG Gang. Clinical effect and safety evaluation of microsurgery associated with Gamma Knife radiosurgery for large meningiomas in sellar region[J]. Journal of Jilin University Medicine Edition, 2015, 41(06): 1255-1259.

参考文献

[1] 张祎年,黄文彪,潘亚文.鞍区脑膜瘤的显微手术治疗及预后影响因素分析[J].中国临床神经外科杂志,2015,20(1):11-14.

[2] Whittle IR,Smith C,Navoo P,et al.Meningiomas[J].Lancet,2004,363(9420):1535-1543.

[3] 王军,王运杰,欧绍武,等.鞍区脑膜瘤的显微手术治疗[J].中华神经外科杂志,2008,24(9):646-648.

[4] Wang YC,Chuang CC,Wei KC,et al.Skull base atypical meningioma:Long term surgical outcome and prognostic factors[J].Clin Neurol Neurosurg,2015,128:112-116.

[5] 罗斌,刘阿力.伽玛刀治疗脑膜瘤的现状[J].中华神经外科杂志,2014,30(2):208-210.

[6] Sheehan JP,Starke RM,Kano H,et al.Gamma Knife radiosurgery for sellar and parasellar meningiomas:a multicenter study[J].J Neurosurg,2014,120(6):1268-1277.

[7] Aghi MK,Carter BS,Cosgrove GR,et al.Long-term recurrence rates of atypical meningiomas after gross total resection with or without postoperative adjuvant radiation[J].Neurosurgery,2009,64(1):56-60.

[8] Santacroce A,Walier M,Régis J,et al.Long-term tumor control of benign intracranial meningiomas after radiosurgery in a series of 4565 patients[J].Neurosurgery,2012,70(1):32-39.

[9] 简俊红,罗大山.鞍区脑膜瘤的诊断及治疗进展[J].国际神经病学神经外科学杂志,2008,35(1):39-42.

[10] 高宜录,顾志凯,陈建,等.颅内脑膜瘤大小分型的建议及其意义[J].中国临床神经外科志,2004,9(3):170-172.

[11] Simpson D.The recurrence of intracranial meningiomas after surgical treatment[J].J Neurol Neurosurg Psychiatry,1957,20(1):22-39.

[12] 王青松,林婷婷,陈建强,等.CTA检查对脑膜瘤手术切除的应用价值[J].中国微侵袭神经外科杂志,2013,18(4):172-173.

[13] Zhao X,Yu RT,Li JS,et al.Clinical value of multi-slice 3-dimensional computed tomographic angiography in the preoperative assessment of meningioma[J].Exp Ther Med,2013,6(2):475-478.

[14] Bly RA,Su D,Hannaford B,et al.Computer modeled multiportal approaches to the skull base[J].J Neurol Surg B Skull Base,2012,73(6):415-423.

[15] Li XJ,Wan JH,Qian HP,et al.Microneurosurgical treatment of massive tuberculum sellae meningiomas[J].Zhonghua Yi Xue Za Zhi,2011,91(1):44-47.

[16] Chen CM,Huang AP,Kuo LT,et al.Contemporary surgical outcome for skull base meningiomas[J].Neurosurg Rev,2011,34(3):281-296.

[17] Combs SE,Ganswindt U,Foote RL,et al.State-of-the-art treatment alternatives for base of skull meningiomas:complementing and controversial indications for neurosurgery,stereotactic and robotic based radiosurgery or modern fractionated radiation techniques[J].Radiat Oncol,2012,29(7):226.doi:10.1186/1748-717x-7-226.

[18] Starke RM,Williams BJ,Hiles C,et al.Gamma knife surgery for skull base meningiomas[J].J Neurosurg,2012,116(3):588-597.

显微手术辅助γ刀治疗鞍区大型脑膜瘤的临床效果和安全性评价

Clinical effect and safety evaluation of microsurgery associated with Gamma Knife radiosurgery for large meningiomas in sellar region

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