發(fā)布時(shí)間：2018-03-05 23:07

  本文選題：雙側(cè)大腦鐮旁腦膜瘤　切入點(diǎn)：分型　出處：《山東大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的： 探討雙側(cè)大腦鐮旁腦膜瘤的臨床分型與手術(shù)治療。 方法： 回顧性分析山東大學(xué)齊魯醫(yī)院自2002年1月至2012年12月期間收治的顱內(nèi)腦膜瘤的患者共1503例患者,篩選出31例病例符合研究方向并經(jīng)手術(shù)治療的病例,分析其一般資料、臨床表現(xiàn)、影像學(xué)特點(diǎn)、病理特點(diǎn)、手術(shù)情況、術(shù)后情況、治療效果及術(shù)后隨訪結(jié)果,根據(jù)大腦鐮兩側(cè)腫瘤的基底、對(duì)稱性及基底間距離的情況等因素提出了一個(gè)雙側(cè)大腦鐮旁腦膜瘤的臨床分型及其手術(shù)方案。 結(jié)果： 在符合研究方向的1503例腦膜瘤患者中鐮旁腦膜瘤共117例(約占腦膜瘤病例總數(shù)的7.78%),根據(jù)診斷標(biāo)準(zhǔn),本研究共篩選出31例(約占鐮旁腦膜瘤病例總數(shù)的26.5%)雙側(cè)大腦鐮旁腦膜瘤符合要求,其中共有16例男性患者及15例女性患者。年齡跨度自20歲～81歲,平均年齡54.1歲。病程跨度自1周～9年,平均病程約1.9年。所有腫瘤均以大腦鐮為基底向各個(gè)方向發(fā)展,向上侵犯上矢狀竇的15例,向下侵犯下矢狀竇或壓迫胼胝體的6例,包繞胼周動(dòng)脈的1例,向硬膜外發(fā)展侵犯顱骨的1例�；颊叱Ｒ姲Y狀是頭痛、頭暈共23例,惡心、嘔吐共5例,一側(cè)肢體活動(dòng)受限17例,雙下肢活動(dòng)受限2例,肢體感覺異常3例,抽搐4例,視力下降和(或)視野缺損6例,記憶力下降3例,性格改變1例,頭外傷后CT檢查發(fā)現(xiàn)腫瘤的無癥狀患者1例。Simpson Ⅰ級(jí)切除23例,Simpson Ⅱ級(jí)切除4例,Simpson Ⅲ級(jí)切除4例,Simpson Ⅳ級(jí)切除0例。無手術(shù)死亡。所有患者術(shù)后均恢復(fù)良好,癥狀減輕或消失。隨訪3個(gè)月-3年,未見復(fù)發(fā)病例。 結(jié)論： 通過31例雙側(cè)大腦鐮旁腦膜瘤病例的分析,根據(jù)雙側(cè)大腦鐮旁腦膜瘤是否同基底、是否對(duì)稱以及腫瘤間距離的大小等因素將雙側(cè)大腦鐮旁腦膜瘤分為兩大型4個(gè)亞型,分別為ⅠA型為兩側(cè)腫瘤同基底且對(duì)稱(共6例),ⅠB型為兩側(cè)腫瘤同基底且不對(duì)稱(共23例)；ⅡA型為兩側(cè)腫瘤異基底且相距較遠(yuǎn)(共1例),ⅡB型為兩側(cè)腫瘤異基底且相距較近(共1例)。并根據(jù)以上分型指導(dǎo)手術(shù)方式。該分型對(duì)于指導(dǎo)手術(shù)方案,提高手術(shù)療效具有一定的參考價(jià)值。
[Abstract]:Objective:. To investigate the clinical classification and surgical treatment of bilateral paraspinal meningioma. Methods:. A retrospective analysis of 1503 patients with intracranial meningioma admitted from January 2002 to December 2012 in Qilu Hospital of Shandong University was made. 31 cases of intracranial meningioma were screened out, and their general data were analyzed. Clinical manifestations, imaging features, pathological features, surgical conditions, postoperative conditions, therapeutic effects and postoperative follow-up results, according to the base of bilateral tumors of sickle cerebri, A clinical classification and surgical scheme of bilateral paraspinal meningioma were proposed for symmetry and distance between bases. Results:. Of the 1503 cases of meningioma in accordance with the research direction, 117 cases (about 7.78% of the total number of meningioma cases) were paraxillar meningiomas, according to the diagnostic criteria, A total of 31 cases (about 26.5% of the total number of cases of paraspinal meningioma) were selected in this study, including 16 male patients and 15 female patients. The age ranged from 20 to 81 years old. The mean age was 54.1 years. The course of disease ranged from 1 week to 9 years, and the average duration was about 1.9 years. All tumors developed in all directions with sickle cerebri as the base, 15 cases with upward invasion of the superior sagittal sinus, and 6 cases with downward invasion of the inferior sagittal sinus or compression of the corpus callosum. The common symptoms were headache, dizziness (23 cases), nausea and vomiting (5 cases), limited movement of one limb (17 cases), and limited movement of both lower limbs (2 cases), the common symptoms were headache, dizziness (23 cases), nausea and vomiting (5 cases), limited movement of one side of extremity (17 cases) and limited movement of lower limbs (2 cases). There were 3 cases of limb sensory abnormality, 4 cases of convulsion, 6 cases of vision loss and / or visual field defect, 3 cases of memory loss, and 1 case of personality change. Ct examination after head trauma showed that 1 case of asymptomatic tumor was resected by Simpson 鈪，

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