鞍上脑膜瘤

 

　　A 59-year-old woman presented to us with a few years history of decreased vision. She had an outside CT scan showing an enhancing lesion in the suprasellar area. The neurological examination was positive for severely decreased vision in both eyes, left more then right. There was primary optic atrophy in the left eye. MRI scans confirmed the CT findings, showing an enhancing lesion in the suprasellar region.Through a bifrontal craniot-omy a suprasellar tumor originating from the tuberculum sellae enveloping the supraclmoid ICA and both optic nerves and extending Into the sella turcica was completely removed. The postoperative course was uncomplicated with improvement of vision on the right. Postoperative CT showed complete tumor removal.

 

　　Case 18: Tuberculum sellae-planum sphe noidale meningioma

 

　　鞍结节蝶骨平台脑膜瘤

 

　　A 58-year-old man was diagnosed as having a predominantly intracranial meningioma en plaque of the anterior skull base in the midline area,extending from the tuberculum sellae and pla-num sphenoidale to the crista galli. The tumor was exposed in-tradurally through a right frontal craniotomy. The compressed right optic nerve and internal carotid artery were identified and freed  from tumor. Then the optic chiasm and left optic nerve? completely encased by tumor, were freed by piecemeal removal of the neoplasm. Residual tumor on the tuberculum sellae and portions of the planum sphenoidale were removed with the diamond burr.   The bone defect was closed in two layers with lyoph-ilized dura and a galeal pericranial flap.

 

　　Case 19: Meningioma of the left optic sheath

 

　　左视神经鞘脑膜瘤

 

　　A 33-year-old woman had a 7-year history of progressive vis-eterioration culminating in amaurosis. Axial CT scans with oblique reconstruction showed a dense tumorlike swelling along the course of the optic nerve.The presence of amaurosis despite the small tumor size implied that optic nerve function had been damaged by mfiltrative growth. The tumor was approached through a right frontotemporal osteoplastic craniotomy with ex-tradural exposure of the orbital roof. The orbital roof was removed microsurgically with the diamond burr, and the optic c** was unroofed. The tumor was exposed by incising the dural cuff around the optic nerve.The nerve and surrounding tumor were resected with adequate margins posteriorly and also close to the globe. Salvage of the optic nerve was impossible due to inftl-trative growth.

 

　　Case 20: Clivus meningioma

 

　　斜坡脑膜瘤

 

　　A 63-year-old women came to our attention with a 2-year history of double vision when looking to right.  Neurological examination disclosed a right abducens paresis and a left hemipare-sis, worse in the arm. Audiogram showed a 50dB hearing loss between 1. 5 and 3 kHz on the right. CT and MRI scans demonstrated a right prepontine extraxial mass at the level of the middle pons. The patient was operated on in the semisiting position with the head tilted 30° to the right and slightly flexed. A lateral suboccipital craniectomy was used to expose the right cerebellar hemisphere flush to the petrous pyramid. The dura v/as opened just medial to the sigmoid sinus,and cerebrospinal fluid was drained from the lateral cerebellomedullary cistern. After medial retraction of the cerebellar hemisphere and visual exploration of the lower cerebellopontlne cistern it was evident that the lower cranial nerves (IX-XI) as  well as the YE-VB complex were mildly displaced posteriorly by the prepontlne mass. Nerve V was pos-terosuperiorly displaced. The tumor was completely removed working around the nerve W-VB complex. During tumor removal the auditory evoked potentials were permanently lost? and nerve VB was consequently cut, making tumor removal somewhat easier.  The tumor originated from the dural entrance of nerve VI which was,both proximally and distally to this point, totally engulfed by tumor.It was possible to remove the tumor completely, preserving the VI function. In addition to loss of the nerve VIII function, the postoperative neurological examination showed decreased hemiparesis and improvement of the abducens function, which returned to normal  in 6 months.

 

　　Case 21: A recurrent inferior clival menin gioma (with far lateral approach)

 

　　复发性斜坡下段脑膜瘤（远外侧入路）

 

　　A 28-year-old female had neuro-fibromatosis type II.   She had 11 operations before presenting to our institution with increasing problems of gait and the development of moderate n-paresis. Diagnostic studies demonstrated a clival meningiorna compressing and shifting the medulla and upper cervical.two previous attempts to resect the tumor from the stand-n-iidhne, posterior fossa craniectomy, C1-C2 lammectomy approach had been made. At the last operation, damage to the vertebral artery had caused extensive hemorrhage and required packing with muslin to control.

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