高龄患者中央区巨大脑膜瘤的显微外科治疗

摘要

目的：探讨高龄患者中央区巨大脑膜瘤的病史特点、治疗方法、手术决策、围手术期处理及疗效。方法回顾性分析70岁以上运动功能区脑膜瘤45例患者的临床表现和病史特点，分析治疗方法的选择、手术决策、围手术期及术后处理与疗效的关系。结果切除范围根据改良Simpson分级，Ⅰ级切除者32例，Ⅱ级切除者13例。术后患者全部存活，出现肺部感染5例，心律不齐6例，消化道出血2例，继发性脑梗塞3例，迟发性颅内血肿2例。术后随访3月～3年，均未见复发，运动功能较术前均有明显改善，恢复正常行走能力，有5例出现记忆力下降。结论高龄患者中央区巨大脑膜瘤与矢状窦、中央沟静脉、外侧裂血管及重要神经结构关系紧密，采用显微神经外科技术，中央区巨大脑膜瘤的高龄患者可取得不错的疗效，但术后易出现各种并发症。%Objective To discuss the diagnosis ,the microsurgery ,the perioperative management and the effect of the big size meningeoma in brain central area .Methods The clinical data of 45 patients over 70 years old with large meningeoma in central area were analyzed retrospectively . Results Simpson grade Ⅰresection were achieved in 32 patients ,grade Ⅱin 13 .At postoperative pulmonary infection in 5 cases,arrhythmia in 6,hemorrhage of digestive tract in 2,secondary cerebral infarction in 3 and intracranial hematoma in 2.Memory decline in 5 cases.No hemiparalysis happend and no patient died .All patients were followed up for 3 months to 3 years without recurrence .Conclusions Central area giant meningioma in elderly patients have close relation with sagittal sinus , central sulcus , lateral fissure vascular and neural structure .The neurosurgerical operation with microscopic technique for giant meningiomas in central area in elderly patients can get good curative effect , but postoperative complications are easy to happen .