Bassiouni Hischam, Hunold Anja, Asgari Siamak, Stolke Dietmar
Department of Neurosurgery, University Hospital Essen, Essen, Germany.
Neurosurgery. 2004 Jul;55(1):108-16; discussion 116-8. doi: 10.1227/01.neu.0000126886.48372.49.
Even during the microsurgical era, tentorial meningiomas present a formidable surgical challenge when tumor involves critical neurovascular structures. We report our experience with tentorial meningioma with regard to clinical presentation, diagnostic workup, microsurgical technique, complications, and follow-up results.
In a retrospective study, we reviewed the medical charts, neuroimaging data, and follow-up data of patients treated microsurgically for tentorial meningioma in our department between January 1989 and June 2002. Patients were routinely scheduled for clinical and radiological follow-up 6 months and 1 year after surgery. Thereafter, follow-up was performed every 1 or 2 years on the basis of the results of each follow-up examination.
The main presenting symptoms of the patients (69 women and 12 men) were headache (75%), dizziness (49%), and gait disturbance (46%). The leading neurological signs were gait ataxia (52%) and cranial nerve deficits (28%). Extent of tumor resection was Simpson Grade I in 29 patients, Grade II in 45 patients, Grade III in 1 patient, Grade IV in 4 patients, and unknown in 2 patients. Permanent surgical morbidity and mortality were 19.8 and 2.5%, respectively. Clinical and magnetic resonance imaging follow-up was available in 74 patients for a period ranging from 1 to 13 years (mean, 5.9 yr). Of these, 64 patients (86%) have resumed normal life activity. Seven patients had tumor recurrence and four underwent reoperation.
Careful preoperative planning of the surgical approach tailored to tumor location and extent is a prerequisite to achieve radical microsurgical tumor resection with minimal morbidity and mortality. Resection of an infiltrated but patent venous sinus is not recommended.
即使在显微外科时代，当幕上脑膜瘤累及关键神经血管结构时，手术治疗仍极具挑战性。我们报告了幕上脑膜瘤在临床表现、诊断检查、显微外科技术、并发症及随访结果方面的经验。
在一项回顾性研究中，我们查阅了1989年1月至2002年6月间在我科接受幕上脑膜瘤显微手术治疗患者的病历、神经影像资料及随访数据。患者术后6个月和1年常规安排临床及影像学随访。此后，根据每次随访检查结果，每1或2年进行一次随访。
患者（69例女性和12例男性）的主要症状为头痛（75%）、头晕（49%）和步态障碍（46%）。主要神经体征为步态共济失调（52%）和脑神经功能缺损（28%）。肿瘤切除程度为辛普森一级的有29例患者，二级的有45例患者，三级的有1例患者，四级的有4例患者，2例患者情况不明。永久性手术致残率和死亡率分别为19.8%和2.5%。74例患者获得了1至13年（平均5.9年）的临床及磁共振成像随访。其中，64例患者（86%）已恢复正常生活活动。7例患者肿瘤复发，4例接受了再次手术。
根据肿瘤位置和范围精心制定术前手术方案，是实现显微外科肿瘤根治性切除并将发病率和死亡率降至最低的前提条件。不建议切除受浸润但仍通畅的静脉窦。
