单侧额下入路显微切除嗅沟脑膜瘤 Microsurgical Removal of Olfactory Groove Meningiomas via the Unilateral Subfrontal Approach

目的：探讨单侧额下入路显微切除嗅沟脑膜瘤的技巧和疗效。方法：在2004年1月至2015年5月采用经单侧额下入路显微切除巨大嗅沟脑膜瘤45例，其中男11例，女34例；平均年龄49.2岁(22~78岁)。肿瘤最大直径平均4.9 cm (2.2 cm~8.1 cm)。回顾性分析所有患者的临床数据、影像特征、手术记录和预后，采用非配对资料χ2检验结果连续性校正法分析预后影响因素。结果：全切(Simpson grade I/II/III)41例(91.1%)，少许残留4例(8.9%)，其中1例行伽玛刀治疗。主要并发症：颅内感染3例，额叶挫伤5例(11.1%)，其中伴血肿需手术清除1例。新增嗅觉损失9例(20.0%)，额叶损伤症状3例，脑脊液漏2例，视力减退1例，脑肿胀1例，癫痫发作1例，脑积水1例。出院后3~6个月，预后良好38例(84.4%)，中残6例(13.3%)，重残1例(2.2%)术前KPS评分 ≤ 70与不良预后相关(χ2 = 5.139, P = 0.023)。41例(91.1%)获随访，平均随访时间42.6个月(3~107个月)，KPS计分85.2分；3例(7.3%)复发，均行伽玛刀治疗，1例再手术。结论：应用适宜手术技巧，单侧额下入路显微切除巨大嗅沟脑膜瘤疗效确切，并发症较少；术前KPS ≤ 70分是嗅沟脑膜瘤手术不良预后因素。 Objective: To investigate the techniques and clinical effects for removal of olfactory groove meningiomas (OGMs) via unilateral subfrontal approach. Methods: Between January 2004 and May 2015, a total of 45 OGM patients were operated on via the unilateral subfrontal approach. There were 11 male patients and 34 female patients. Their mean age was 49.2 (22~78) years. The average maximal tumor diameter was 4.9 cm (2.2 cm - 8.1 cm)). The clinical data, radiological findings, surgical records and outcome of patients were retrospectively analyzed, and the prognostic factors were analyzed by using of the unpaired χ2 test with continuity correction. Results: Apparent complete tumor removal was achieved in 41 patients (91.1%). Four patients (8.9%) had minimal residual tumors, 3 of which had gamma knife radiosurgery. There was no surgical mortality. The main operative complications included new anosmia (9 cases), intracranial infection (3 cases), frontal contusion (5 cases), frontal mental changes (3 cases), cerebrospinal fluid leakage (2 cases), and visual deficits\brain swelling\seizures and hydrocephalus (1 case) respectively. At 3 - 6 months after discharge, 38 (84.4%) patients had a good recovery, 6 (13.3%) were moderately disabled and 1 (2.2%) was severely disabled. The preoperative KPS ≤ 70 was the cause of unfavorable prognosis (χ2 = 5.139, P = 0.023). During the mean follow-up of 42.6 months (range, 3 - 107 months) for 41 patients, the average KPS was 85.2. Tumor recurred in 3 cases, all being treated with gamma knife radiosurgery, one of which required reoperation. Conclusion: By using optimal operative techniques, OGMs can be removed safely via the unilateral subfrontal approach with relatively low morbidity. The preoperative KPS ≤ 70 is an unfavorable prognostic factor for OGM resection.