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目的:回顾性分析前颅窝脑膜瘤伴瘤周水肿的临床特征,探讨术前、术中及术后的治疗经验。方法:分析我科前颅窝脑膜瘤伴有瘤周水肿9例临床资料,肿瘤位于:蝶骨嵴4例,前颅窝底及嗅沟5例。年龄37-68岁,平均52岁。结果:术后病理:WHO-Ⅰ级6例(66.7%),WHO-Ⅱ级2例(22.2%),WHO-Ⅲ级1例(11.1%)。9例术后脑水肿加重5例(55.6%),60岁以上老年患者发生率达3例(60%),2例因发生恶性脑水肿死亡。结论:术前充分告知和手术预案及手术路径的选择,术中对动、静脉血管尤其Heubner回返动脉的识别、保护是预防术后脑水肿加重的必需和有效措施。术后严密观察和细致护理,脱水药的应用,甚至及时的再次手术可提高此类患者手术的安全性,降低术后并发症的发生率和死亡率。
Objective: To retrospectively analyze the clinical features of anterior fossa meningiomas with peritumoral edema and to explore the experience of preoperative, intraoperative and postoperative treatment. Methods: The clinical data of 9 cases of anterior segment tumor meningioma accompanied with peritumoral edema were analyzed. The tumor was located in 4 cases of sphenoid ridge, 5 cases of anterior skull base and olfactory groove. Age 37-68 years old, average 52 years old. Results: Postoperative pathology: WHO-Ⅰ grade in 6 cases (66.7%), WHO-Ⅱ grade in 2 cases (22.2%) and WHO-Ⅲ grade in 1 case (11.1%). Nine cases of postoperative cerebral edema aggravated in 5 cases (55.6%), the incidence of elderly patients over the age of 60 in 3 cases (60%), 2 patients died of malignant cerebral edema. Conclusion: Preoperative informed and surgical options and surgical path selection, intraoperative arterial and venous blood vessels, especially the Heubner return artery identification and protection is to prevent postoperative cerebral edema increase the necessary and effective measures. Close observation and meticulous care after surgery, the application of dehydration medicine, and even timely reoperation can improve the safety of such patients surgery and reduce the incidence of postoperative complications and mortality.