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

Abstract

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

CLC Number:

R739.4

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.

References

[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.

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

PDF (PC)

Like

Knowledge

Abstract

Cite this article

share this article

References

Related Articles 3

Metrics

Comments

Recommended 10

[1]	MA Xiaoshan, SUN Jing, QU Limei, CAO Yingkun, LIU Wenbin, ZHAO Yao, LI Yunqian. Atypical choroid plexus papilloma in suprasellar region of elderly with impaired vision as main symptom:A case report and literature review [J]. Journal of Jilin University(Medicine Edition), 2020, 46(05): 1065-1069.
[2]	WANG Peng, LI Nuo, HUANG Shan, LI Tienan, LANG Xiaofeng, LIU Wei. Comparison of clinical effects of different surgical methods in patients with supratentorial hypertensive intracerebral hemorrhage [J]. Journal of Jilin University(Medicine Edition), 2019, 45(03): 667-672.
[3]	LIU Jia-bei,LI Chen,GU Rui,GAO Zhong-li,WANG Jin-cheng. Techniques and evaluation of microsurgical resection of 　intradural extramedullary tumors through hemilaminectomy [J]. Journal of Jilin University Medicine Edition, 2013, 39(5): 991-994.