教 师 : 罗　林 教授

昆明医学院第三附属医院神经外科

Meningioma

A 59-year-old women presented with a 2-year history of progressive dementia. Clinical examination disclosed bilateral anosmia and a concentric contraction of the left visual field with visual acuity reduced to 20%. Plain radiographs showed erosion of the cribriform plate and CT scans demonstrated a large mass lesion the anterior cerebral arteries and pathological staining of the tumor vessels supplied via the ophthalmic arteries. The tumor was approached through a bifrontal craniotomy and exposed by gentle retraction of the frontal lobes. Piecemeal removal of the highly vascular tumor was accoplished by bipolar coagulation and resection. Both anterior cerebral arteries, the optic nerves, and the optic chiasm were microsurgically freed of tumor.

After removal of the dura bordering on the tumor, the thickened crista galli and cribriform plate were removed with the diamond burr. The small skull base defect was closed in two layers with a dural graft and a galeal pericranial flap. The postoperative course was uncomplicated, and CT scans confirmed total tumor removal. One year later, the patient was clinically asymptomatic and recurrence-free.

Diagnosis : Olfactory groove meningioma

Incidence

Common site Clinical manifestation

Examination Diagnosis Treatment

Most of meningiomas come from the cell of arachnoid.

Incidence

A very common condition with a variety of causes.

The second most commonly .

More commonly seen in female, a ratio of 2:1

人群（ 10万人）

颅内 0.3 － 8.4，椎管内 0.08 － 0.3

颅内肿瘤 15％－ 24％（男性 20％，女性 36％）

椎管内肿瘤 22％－ 43％（男性 21％，女性 58％）

男：女 1 ： 2（颅内）， 1 ： 5（椎管内）

The most common site

Sagittal sinus Tuberculum sellae Plate of ethmoid Cavernous sinus Pons-cerebellum angle (CPA) Tentorium of cerebellum

Sagittal sinus

Tuberculum sellae

Plate of

ethmoid

Pons-cerebellum

angle (CPA)

Tentorium of cerebellum

材料与方法Clinical

manifestation

大部分属良性肿瘤，生长慢，病程长。 局灶型症状：往往以头痛（ headache)和癫痫（ epilepsy）为首发症状，根据部位不同，还可以出现视力、视野、嗅觉或听觉障碍及肢体运动障碍等症状。

颅高压症状不太明显。 对颅骨的影响：骨板受压变薄或骨板破坏。

Special examination

1.electroencephalogram (EEG) 2.plain radiographs 3.cerebral angiography 4.CT 5.MRI

cerebral angiography

Diagnosis

1. Clinical manifestation

2. Special examination

囊性脑膜瘤与胶质瘤鉴别

1.位于矢状窦旁囊变肿瘤应想到脑膜瘤。 2.术中活检。 3.脑血管造影见肿瘤有颈外动脉供血者多为脑膜瘤。

3. 托吡酯、拉莫三嗪对致痫大鼠模型海马神经元有保护作用，能减轻癫痫发作后的海马神经元的变性、坏死和凋亡，推测作用机制可能与增强癫痫大鼠海马神经元 bcl-2基因表达和降低 bax基因表达有关。

Treatment

1.opertaion

2.radiotherapy (γ-knief X-knief)

3.others

Grade Description

Ⅰ Complete macroscopic tumor removal with excision of involved dura and bone

Ⅱ Complete macroscopic tumor removal with coagulation of dura and (or) bone

Ⅲ Complete macroscopic tumor removal but no satisfactory attempt to deal with involved dura and bone

Ⅳ Intracranial tumor left in situ

Ⅴ Tumor decompression only

Simpson Scale for Meningioma Resection