Department of Neurosurgery, Fu Xing Hospital, Capital Medical University, Beijing 100038, China. Email:
Chin Med J (Engl). 2013 Dec;126(23):4470-6.
Large and giant medial sphenoid wing meningiomas that are located deeply in the skull base where they are closely bounded by cavernous sinus, optic nerve, and internal carotid artery make the gross resection hard to achieve. Also, this kind of meningiomas is often accompanied by a series of severe complications. Therefore, it was regarded as a formidable challenge to even the most experienced neurosurgeons. This study aimed to investigate the clinical features and management experience of patients with large and giant medial sphenoid wing meningiomas.
In this study, 53 patients (33 female and 20 male, mean age of 47.5 years) with large and giant medial sphenoid wing meningiomas were treated surgically between April 2004 to March 2012, with their clinical features analyzed, management experience collected, and treatment results investigated retrospectively.
In this study, gross total resection (Simpson I and II) was applied in 44 patients (83%). Fifty-three patients had accepted the routine computed tomography scan and magnetic resonance imaging scan as postoperative neuroradiological evaluation. Their performance showed surgical complications of vascular lesions and helped us evaluate patients' conditions, respectively. Meanwhile, the drugs resisting cerebral angiospasm, such as Nimodipine, were infused in every postoperative patient through vein as routine. As a result, 11 patients (21%) were found to have secondary injury of cranial nerves II, III, and IV, and nine patients got recovered during the long-term observing follow-up period. Temporary surgical complications of vascular lesions occurred after surgery, such as cerebral angiospasm, ischemia, and edema; 24 patients (45%) appeared to have infarction and dyskinesia of limbs. Overall, visual ability was improved in 41 patients (77%). No patient died during the process.
Microsurgical treatment may be the most effective method for the large and giant medial sphenoid wing meningiomas. The surgical strategy should focus on survival and postoperative living quality.
大型和巨大型蝶骨翼内侧脑膜瘤位于颅底深处，与海绵窦、视神经和颈内动脉紧密相邻，因此难以实现肉眼全切。此外，此类脑膜瘤常伴有一系列严重并发症，即使是经验最丰富的神经外科医生也认为这是一个艰巨的挑战。本研究旨在探讨大型和巨大型蝶骨翼内侧脑膜瘤患者的临床特征和治疗经验。
本研究回顾性分析了 2004 年 4 月至 2012 年 3 月期间 53 例（33 例女性，20 例男性，平均年龄 47.5 岁）大型和巨大型蝶骨翼内侧脑膜瘤患者的临床特征、治疗经验和治疗结果。
本研究中，44 例患者（83%）行肉眼全切术（Simpson I 和 II 级）。53 例患者术后均行常规计算机断层扫描和磁共振成像检查进行神经影像学评估。结果显示手术中血管损伤并发症，有助于评估患者病情。同时，常规静脉滴注尼莫地平等抗脑血管痉挛药物。术后发现 11 例（21%）患者出现颅神经 II、III、IV 继发性损伤，9 例患者在长期观察随访期间恢复。术后发生血管损伤等暂时性手术并发症，如脑血管痉挛、缺血和水肿；24 例（45%）患者出现肢体梗死和运动障碍。总体而言，41 例（77%）患者的视力得到改善。治疗过程中无患者死亡。
显微外科治疗可能是大型和巨大型蝶骨翼内侧脑膜瘤最有效的治疗方法。手术策略应注重生存和术后生活质量。
