DeMonte F, Smith H K, al-Mefty O
Department of Neurosurgery, M.D. Anderson Cancer Center, Houston, Texas.
J Neurosurg. 1994 Aug;81(2):245-51. doi: 10.3171/jns.1994.81.2.0245.
Despite recent advances in surgery of the cavernous sinus, meningiomas in that area offer a formidable challenge. The rationale for aggressive surgical removal of cavernous sinus meningiomas is based on the presumption that the extent of removal is inversely related to the rate of recurrence. Over the past 10 years, 41 patients with histologically benign meningiomas involving the cavernous sinus underwent aggressive surgery. Total removal, as confirmed by intraoperative inspection and postoperative radiological studies, was achieved in 31 patients (76%). Twelve patients have been followed for more than 5 years; 10 underwent total tumor removal and only one of these experienced recurrence (5 years after surgery). The other two patients underwent subtotal removal and had symptomatic and radiological evidence of regrowth 3 and 4 years after surgery. Pre-existing cranial nerve deficits improved in only 14% of the patients, remained unchanged in 80%, and worsened permanently in 6%. Seven patients experienced a total of 10 new cranial nerve deficits, four of which involved the nerves subserving ocular motor function. Extraocular muscle function did not worsen in the 25 patients with a seeing eye ipsilateral to the tumor, and no instance of visual worsening occurred. Two patients died 4 months after surgery, one from severe delayed vasospasm and hypothalamic infarction and the other because of a myocardial infarction. Another patient died from a pulmonary embolus on the 9th postoperative day. There were three instances of cerebral ischemia; one was transient, lasting less than 24 hours, while two were related to injury of the middle cerebral artery and resulted in residual hemiplegia. Other complications included three cases of nonfatal pulmonary emboli, two cerebrospinal fluid leaks, and one instance each of exposure keratitis, acute hypothyroidism, and cerebral edema.
尽管海绵窦手术近期取得了进展，但该区域的脑膜瘤仍然是一项艰巨的挑战。积极手术切除海绵窦脑膜瘤的理论依据是基于这样一种假设，即切除范围与复发率呈负相关。在过去10年中，41例组织学上为良性的累及海绵窦的脑膜瘤患者接受了积极手术。经术中检查和术后影像学研究证实，31例患者（76%）实现了全切。12例患者随访超过5年；10例患者肿瘤全切，其中只有1例出现复发（术后5年）。另外2例患者接受了次全切，术后3年和4年出现了症状性和影像学上的肿瘤复发证据。术前存在的脑神经功能缺损仅14%的患者有所改善，80%保持不变，6%永久性恶化。7例患者共出现10例新的脑神经功能缺损，其中4例涉及支配眼球运动功能的神经。25例患侧眼视力正常的患者眼外肌功能未恶化，且未出现视力恶化的情况。2例患者术后4个月死亡，1例死于严重的迟发性血管痉挛和下丘脑梗死，另1例死于心肌梗死。另1例患者术后第9天死于肺栓塞。发生了3例脑缺血；1例为短暂性，持续时间不到24小时，另2例与大脑中动脉损伤有关，导致残留偏瘫。其他并发症包括3例非致命性肺栓塞、2例脑脊液漏，以及各1例暴露性角膜炎、急性甲状腺功能减退和脑水肿。
