鞍结节脑膜瘤的内镜经鼻及显微镜经颅入路的个体化选择及36例病例总结

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目的通过分析患者肿瘤形态临床表现及影像资料，为更精准选择手术方案提供依据。方法回顾性分析四川大学华西医院神经外科单医疗组2019年2月—2021年2月经鼻及经颅入路治疗的36例鞍结节脑膜瘤患者资料，结合患者临床特征及国际评分系统，探讨选择手术入路需要分析的因素。结果本组患者中，神经内镜经鼻入路24例，显微镜经颅入路12例，随访时间24～48个月，结合最新的鞍结节脑膜瘤手术入路评分系统及本组诊疗经验进行综合判定，选择不同手术入路。随访均未见复发。结论鞍结节脑膜瘤术前影像学评分有助于个体化选择手术入路，内镜经鼻入路及显微镜经颅入路相互补充，合理选择可全切肿瘤、减少并发症，改善预后。

Objective To provide a basis for more accurate surgical planning by analyzing the clinical manifestations and imaging data of the patient’s tumor morphology. Methods The data of 36 patients with sellar nodule meningioma treated through nasal and transcranial approaches in the single medical group, Department of Neurosurgery, West China Hospital Affiliated to Sichuan University from February 2019 to February 2021 were analyzed retrospectively. Combining the clinical characteristics of the patients and the international scoring system, this study explores the factors that need to be analyzed when selecting surgical approaches. Results Among all the patients, 24 cases underwent neuroendoscopic transnasal approach and 12 underwent microscopic transcranial approach. The follow-up period was 24-48 months. Based on the latest scoring system for surgical approaches for tuberculum sellar meningioma and diagnostic and treatment experience, different surgical approaches were selected. No recurrence was observed during follow-up. Conclusions Preoperative imaging scoring of tuberculum sellae meningiomas are used for individualized selection of surgical approach. The endoscopic endonasal transsphenoidal and microscopic transcranial approaches complement each other, and a reasonable choice can completely resect the tumor, reduce complications, and improve the prognosis.