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目的探讨内侧型蝶骨嵴脑膜瘤分型及治疗方法。方法对29例患行的影像学资料、治疗方法和结果进行回顾性分析。结果根据MRI所见肿瘤主体部位分为Ⅰ型(颅前窝型)9例,全切除率100%；Ⅱ型(颅中窝型)16例,手术治疗15例,全切除10例,次全切除4例,大部切除1例；Ⅲ型(混合型)4例,次全切除3例,大部切除1例；术后视力改善12例,无变化2例,视力恶化1例,一过性偏瘫6例,一过性动眼神经麻痹2例,死亡1例；1例Ⅱ型患者拒绝手术行X-刀治疗,放疗后3个月因脑水肿脑疝行减压术,半年复查MRI见肿瘤体积缩小,肿瘤中心坏死；未能令切病人均行放疗,8例得以随访3个月-5年未见肿瘤增大。结论颅前窝为主的肿瘤全切除率极高,颅中窝型和混合型全切除率较低；对残余肿瘤应行放疗,在术后2个月左右脑水肿消退后行立体定向放疗可减少放疗引起的脑损伤,减少肿瘤复发机会。
Objective To investigate the classification and treatment of medial sphenoid ridge meningioma. Methods The imaging data, treatment methods and results of 29 cases were retrospectively analyzed. Results According to MRI, 9 cases were classified into type Ⅰ (anterior cranial fossa) and 100% for type Ⅰ (cranial fossa), 15 cases were treated surgically, 10 cases were totally resected, 4 cases were resected, 1 case was mostly resected, 4 cases were type Ⅲ (mixed type), 3 cases were subtotally resected and 1 case was mostly resected. The visual acuity was improved in 12 cases, no change in 2 cases, visual acuity in 1 case, 6 cases of sexual hemiplegia, transient oculomotor nerve paralysis in 2 cases, 1 case of death; 1 case of type Ⅱ patients refused surgery X-knife treatment, 3 months after radiotherapy due to hydrocephalus brain hernia decompression, six months review MRI See tumor size reduced tumor center necrosis; failed to make the patient underwent radiotherapy, 8 patients were followed up for 3 months - 5 years no tumor increased. Conclusions The total resection rate of the tumors in the anterior cranial fossa is very high, and the total excision rate in the middle cranial fossa type and mixed type is low. Radiotherapy should be performed on the residual tumor. Stereotactic radiotherapy may be performed after the cerebral edema subsides about 2 months after surgery Reduce brain damage caused by radiotherapy and reduce the chance of tumor recurrence.