摘要:
[目的]探究采用显微外科术配合伽玛刀对矢状窦旁脑膜瘤治疗的临床疗效以及术后复发情况.[方法]回顾性分析2012年4月至2015年4月本院收治的50例矢状窦旁脑膜瘤患者的临床资料,肿瘤位于矢状窦前1/3、中1/3、后1/3分别为15例、22例、13例,应用显微神经外科术治疗,对术后肿瘤切除残留者配合伽玛刀治疗.随访2年观察组术后复发情况,记录所有患者肿瘤全切除情况,随访术后患者各类并发症发生及复发率情况,比较治疗前后生活质量KPS评分.[结果]SimpsonⅠ级、Ⅱ级、Ⅲ级分别为16例(32.00%)、8例(16.00%)、15例(30.00%),全切除率为78.00%;SimpsonⅣ级切除11例(22.00%),次全切除率为22.00%.Simpson Ⅱ级、Ⅲ级、Ⅳ级切除者均进行了伽玛刀治疗,术后随访2年,术后临床症状基本消失,无病死病例.术后肿瘤复发4例(8.00%),其中Ⅱ级、Ⅲ 级复发1例,Ⅳ级复发2例.肿瘤病理检查结果显示:良性肿瘤44例(88.00%),恶性肿瘤6例(12.00%).患者术前生活质量KPS评分为(72.67 ± 3.32)分,术后为(86.43 ± 4.02)分,术后KPS评分显著高于术前,差异有统计学意义(t =3.16,P <0.05).术后发生并发症共18例(36.00%),其中神经功能损伤9例(18.00%)、抽痉3例(6.00%)、血肿4(8.00%)、脑肿胀2例(4.00%).[结论]显微神经外科术治疗矢状窦旁脑膜瘤具有良好的临床疗效,对术后肿瘤切除残留者配合伽玛刀治疗可有效控制肿瘤复发,且能够显著提高患者生活质量,值得临床推广应用.%[Objective] To study effects of microneurosurgical techniques combined with gamma knives on pa-rasagittal meningioma and analyze the postoperative recurrent rate.[Methods]A total of 50 patients with parasag-ittal meningioma treated in our hospital from April 2012 to April 2015 were selected as study subjects.With re-gards to tumor location,there were 15 cases in the anterior third,22 cases in middle third and 13 cases in posterior third of the sagittal sinus.Retrospective analysis was conducted on all clinical data.Microneurosurgical techniques were employed as the main treatment,and gamma knife was adopted to handle tumor remnants after surgery. Tumor resection status(classified as benign or malignant through pathological examination)were recorded for all patients.Patients were surveyed for incidence and recurrence rates of various complications through 2 years of fol-low-ups.KPS scores of quality of life were compared before and after treatment.[Results]According to the Simp-son resection classification criteria,there were 16 cases of grade Ⅰ(32%),8 cases of grade Ⅱ(30%)and 15 cases of grade Ⅲ.The total resection rate of tumors was 78%.There were 11 cases(22.00%)of Simpson grade Ⅳ with a subtotal resection rate of 22.00%.The gamma knife treatment was performed on the Simpson grade Ⅱ,Ⅲ,andⅣ resections.After 2 years of follow-up,the clinical symptoms nearly disappeared,and there were no cases of death.Postoperative tumor recurrence occurred in 4 patients(8.00%),including 1 case in both grade Ⅱ and gradeⅢ and 2 cases in grade Ⅳ.Based on pathological diagnosis,there were 44 benign tumors(88.00%)and 6 malig-nant tumors(12.00%).The KPS scores before operation was 72.67 ± 3.32 points,which was lower than that of KPS scores after operation of 86.43 ± 4.02 points;the difference was statistically significant(P <0.05).A total of 18 cases(36.00%)had postoperative complications:9 cases(18.00%)of neurological impairment,3 cases (6.00%)of spasms,4(8.00%)of hematoma,and 2 cases(4.00%)of brain swelling.[Conclusion]Microneuro-surgical treatment of sagittal sinus paraneoplastic meningioma has great clinical effects.After resection of residual tumors by gamma knife treatment,it can effectively control the recurrence of tumors.Microneurosurgical tech-niques combined with gamma knives can significantly improve the quality of life of patients and is worthy of clinical application.