杨堃;TakashiKawase;何理盛;蔡雄;戴琳孙

　　目的探讨侵袭性脑膜瘤的影像特征和手术治疗方法。方法回顾性分析56例侵袭性脑膜瘤患者的临床表现、影像学检查、病理结果及手术治疗情况等资料。结果56例侵袭性脑膜瘤在影像学上表现有颅骨的局部增生(18例),肿瘤侵蚀破坏颅骨(11例),硬脑膜"尾"征(27例),瘤-脑界面部分或完全消失(29例),肿瘤边界毛糙模糊、结节状或指状突出、伪足征(24例),肿瘤粘附或侵入静脉窦或海绵窦(9例),包绕大血管4例,瘤周明显水肿(39例)等。手术切除按Simpson标准分级,其中0级21例,Ⅰ级19例;Ⅱ级9例,Ⅲ级7例。术后随访0.5～8年,痊愈49例,轻度功能障碍7例。无死亡病例,复发4例。结论侵袭性脑膜瘤有较特殊的影像学特征,可为临床诊断和手术治疗提供参考。尽可能地行病灶根治性切除能有效地减少肿瘤的复发。
【作者单位】：海南医学院附属医院神经外科;DepartmentofNeurosurgery SchoolofMedicine;KeioUniversity(Tokyo160-8582;Japan);福建医科大学附属第一医院神经外科;海南医学院附属医院神经外科;福建医科大学附属第一医院神经外科;海南海口570102;福建福州;350005;海南海口570102;福建福州;350005
【关键词】：侵袭性脑膜瘤;磁共振成像;CT;手术
【分类号】：R739.4
【DOI】：CNKI:SUN:ZGLC.0.2007-12-007
【正文快照】：
　　侵袭性脑膜瘤是指向临近的硬脑膜、蛛网膜、脑组织、颅骨及其他组织浸润生长的脑膜瘤[1,2]。脑膜瘤的侵袭性生长是其术后复发的主要原因之一[1,3~6],因此临床上加强对侵袭性脑膜瘤的认识以及采取正确的治疗方法对提高疗效十分重要。本文报告56例经手术及病理证实的侵袭性脑膜瘤的诊治经验。1临床资料1.1一般资料本组病例男性25例,女性31例。年龄12～72岁,平均47岁。病史0.5～15年。1.2临床表现主要表现为头痛、呕吐29例,癫痫发作14例,偏瘫11例,视力减退9例,行走不稳6例,头皮下肿物7例。1.3肿瘤部位脑膜瘤位于大脑凸面23例,大脑镰及矢状窦旁9…
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Imaging Characteristics of Invasive Meningiomas and Surgical Strategy of Treating Them
YANG Kun*;Takashi Kawase;HE Li-sheng;et al . *Department of Neurosurgery;The Affiliated Hospital;Hainan Medical College;Haikou Hainan 571020;China
　Objective To study the imaging characteristics of the invasive meningiomas (including CT and MRI) and surgical strategy of treating them. Method The clinical data of 56 patients with invasive meningiomas, including the clinical manifestations, characteristics on CT and MRI, pathological examination, intraoperative findings and so on, were analyzed retrospectively. Results The imaging characteristics of 56 cases of invasive meningiomas included the cranial hyperostosis in 18 cases, destroyed skull bone in 11, dural tail sign in 27, part or complete disappearance of the brain-tumor interfaces in 29, rough and vague boundaries of the tumors (nodous or digital or pseudopodium sign) in 24, invaded venous sinuses or cavernous sinuses by the tumors in 9, encased great vessels by the tumors in 4, obvious peritumoral brain edema in 39 and so on. According to Simpson standard of resecting tumor, Grade 0 was reached in 21 cases, GradeⅠin 19, GradeⅡ in 9 and Grade Ⅲ in 7. The following up from 6 months to 8 years showed that 49 cases were cured, 7 had slight functional impairment and the tumor recurred in 4 patients. No patients died. Conclusions The invasive meningiomas have some imaging characteristics, which are helpful to diagnosis and making operative plan. The invasive meningiomas should be resected as totally as possible in order to decrease their recurrence.
【Keyword】：Invasive meningioma;Magnetic resonance image;CT;Surgery