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目的探讨改良额底入路切除鞍结节脑膜瘤的临床效果。方法回顾性分析本人自2009年12月至2013年12月来采取不损伤颞肌,不选传统额底入路的“关键孔”点,而选取“美容孔”点,骨瓣大小和位置选择灵活的改良额底入路切除鞍结节脑膜瘤31例的临床资料。结果手术后4例病人癫痫未再发作,无垂体功能低下病例,无尿崩病例,无额纹消失病例,无颞肌萎缩病例。有5例术侧嗅神经断裂。术前有48只眼视力下降,术后有46只眼视力明显改善,有1只眼视力无明显变化,1只眼视力下降。simpsonⅠ级切除25例中,有1例于术后2年复发。simpsonⅡ级切除5例中,有1例于术后1.5年时复发。simpsonⅢ级切除1例,随访2.5年残余肿瘤无明显变化。结论改良额底入路切除鞍结节脑膜瘤具有灵活、安全、暴露充分、切除彻底、损伤轻等优点。
Objective To explore the clinical results of modified frontal approach for resection of saddle nodular meningioma. Methods From December 2009 to December 2013, we retrospectively analyzed the “key hole” points without damaging the temporalis muscles and the traditional frontal approach, and selected “beauty hole” points and bone flap The size and location of the flexible choice of the bottom approach to the removal of nodular meningioma clinical data of 31 cases. Results 4 cases of postoperative epilepsy patients no recurrence, no hypopituitarism cases, no diabetes collapse cases, no pattern disappearance of cases, no cases of temporal muscle atrophy. There were 5 cases of olfactory nerve rupture. Preoperative 48 patients with decreased visual acuity, visual acuity was significantly improved in 46 eyes after surgery, 1 had no significant change in visual acuity, visual acuity decreased in 1 eye. Of the 25 patients who underwent simpson class I resection, 1 had recurrence 2 years after surgery. In 5 cases of simpson Ⅱ grade resection, 1 case had recurrence 1.5 years after operation. One case of simpson Ⅲ grade resection, followed up for 2.5 years, no significant changes in residual tumor. Conclusion The improved frontal approach for the removal of saddle nodular meningioma has the advantages of flexibility, safety, adequate exposure, thorough resection and less damage.