脑膜瘤ppt课件
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脑膜瘤
流行病学
• 发病率：2-3/10万(第六次人口普查：广西
常住人口总数为4602.6629万，列全国第11 位 )则脑膜瘤病人约920-1380万 • 占颅内肿瘤的20% • 男女比例1:2
2
病因
70%以上病人有染色体异常表现：肿瘤抑制 基因位于22号染色体长臂
3
发生于蛛网膜层的 蛛网膜细胞
冠状或者半冠状入路 骨板过中线 显露前颅窝底 修补额窦 大脑前动脉 视神经
19
20
嗅沟脑膜瘤
21
嗅沟脑膜瘤
22
鞍结节脑膜瘤
23
Tips for operation
额颞-眶颧入路
24
25
26
27
28
29
30
31
蝶骨嵴脑膜瘤
32
蝶骨嵴脑膜瘤
33
蝶骨嵴脑膜瘤
34
Tips for operation
11
治疗
• 手术切除
位置 大小 质地 血运 神经侵犯 放疗 化疗
• •
12
Simpson脑膜瘤切除 程度分级
13
5年复发率
I级 II级 III级 IV级 3% 4% 25% 45%
14
Kobayashi修改后分 级系统
15
大脑凸面脑膜瘤
16
额叶脑膜瘤
17
右额叶脑膜瘤
18
Tips for operation
• 内侧与外侧 • 视交叉 • 眶上裂 • 大脑前动脉 • 垂体柄 • 眶下裂 • 海绵窦
35
岩尖脑膜瘤与岩斜 区脑膜瘤
36
岩斜区脑膜瘤
37
岩斜区脑膜瘤
38
Tips for operation
乙状窦前入路：不受横窦影响 乙状窦后入路：显露斜坡区受限 颞下入路：磨掉岩骨尖 颅神经（V-VIII）
43
镰旁脑膜瘤
44
窦汇区脑膜瘤
45
Tips for operation
1、次全切：等待时机 2、全切同时重建“窦”
46
枕骨大孔脑膜瘤
47
Tips for operation
• 枕骨髁入路 • 后组颅神经 • 椎基底动脉
48
49
50
51
52
53
54
颅内多发脑膜瘤
55
谢 谢 大 家
39
乙状窦后
40
迷路后经乳突
41
经耳蜗
42
In evaluating these approaches in our laboratory, we have found that the minimal mastoidectomy gives approximately the same exposure as the retrolabyrinthine approach, but is done at reduced risk since the semicircular canals and facial nerve are not skeletonized . Removing the posterior canal increases access to the posterior fossa, but access is only slightly increased over that achieved with the retrolabyrinthine approach. Removing the superior canal increases access to the middle fossa and petrous apex and reduces the needed retraction of the temporal lobe. The translabyrinthine approach does not significantly increase the access to the area medial to the porus of the internal acoustic meatus over that achieved with the minimal mastoidectomyor retrolabyrinthine approach, but does provide access to the internal auditory canal. The transcochlear modification, in which bone is removed up to the edge of the clivus, does significantly increase access to the front of the brainstem and clivus over that achieved with the lesser degrees of bony resection. The retrosigmoid, the presigmoid minimal mastoidectomy, and the retrolabyrinthine approaches were compared and yielded nearly the same exposure of the cerebellopontine angle, but the retrosigmoid approach did not provide the additional exposure of the middle fossa and petrous apex that could be achieved Βιβλιοθήκη Baidun the combined supra-and infratentorial presigmoid approach.
4
病理类型
5
部位与发病率
6
颅底脑膜瘤常见部位
7
诊断（CT）
等密度、稍高密度、钙化、囊变、出血、均 匀或者不均匀增强
8
诊断（MRI）
等T1、等T2、均一强化、脑膜尾、宽基底、 常见部位
9
诊断（DSA）
提供肿瘤供血血管方面的信息 术前栓塞减少术中出血
10
鉴别诊断
垂体瘤 神经鞘瘤 垂体瘤 脊索瘤 颅咽管瘤 室管膜瘤 脉络丛乳头状瘤
流行病学
• 发病率：2-3/10万(第六次人口普查：广西
常住人口总数为4602.6629万，列全国第11 位 )则脑膜瘤病人约920-1380万 • 占颅内肿瘤的20% • 男女比例1:2
2
病因
70%以上病人有染色体异常表现：肿瘤抑制 基因位于22号染色体长臂
3
发生于蛛网膜层的 蛛网膜细胞
冠状或者半冠状入路 骨板过中线 显露前颅窝底 修补额窦 大脑前动脉 视神经
19
20
嗅沟脑膜瘤
21
嗅沟脑膜瘤
22
鞍结节脑膜瘤
23
Tips for operation
额颞-眶颧入路
24
25
26
27
28
29
30
31
蝶骨嵴脑膜瘤
32
蝶骨嵴脑膜瘤
33
蝶骨嵴脑膜瘤
34
Tips for operation
11
治疗
• 手术切除
位置 大小 质地 血运 神经侵犯 放疗 化疗
• •
12
Simpson脑膜瘤切除 程度分级
13
5年复发率
I级 II级 III级 IV级 3% 4% 25% 45%
14
Kobayashi修改后分 级系统
15
大脑凸面脑膜瘤
16
额叶脑膜瘤
17
右额叶脑膜瘤
18
Tips for operation
• 内侧与外侧 • 视交叉 • 眶上裂 • 大脑前动脉 • 垂体柄 • 眶下裂 • 海绵窦
35
岩尖脑膜瘤与岩斜 区脑膜瘤
36
岩斜区脑膜瘤
37
岩斜区脑膜瘤
38
Tips for operation
乙状窦前入路：不受横窦影响 乙状窦后入路：显露斜坡区受限 颞下入路：磨掉岩骨尖 颅神经（V-VIII）
43
镰旁脑膜瘤
44
窦汇区脑膜瘤
45
Tips for operation
1、次全切：等待时机 2、全切同时重建“窦”
46
枕骨大孔脑膜瘤
47
Tips for operation
• 枕骨髁入路 • 后组颅神经 • 椎基底动脉
48
49
50
51
52
53
54
颅内多发脑膜瘤
55
谢 谢 大 家
39
乙状窦后
40
迷路后经乳突
41
经耳蜗
42
In evaluating these approaches in our laboratory, we have found that the minimal mastoidectomy gives approximately the same exposure as the retrolabyrinthine approach, but is done at reduced risk since the semicircular canals and facial nerve are not skeletonized . Removing the posterior canal increases access to the posterior fossa, but access is only slightly increased over that achieved with the retrolabyrinthine approach. Removing the superior canal increases access to the middle fossa and petrous apex and reduces the needed retraction of the temporal lobe. The translabyrinthine approach does not significantly increase the access to the area medial to the porus of the internal acoustic meatus over that achieved with the minimal mastoidectomyor retrolabyrinthine approach, but does provide access to the internal auditory canal. The transcochlear modification, in which bone is removed up to the edge of the clivus, does significantly increase access to the front of the brainstem and clivus over that achieved with the lesser degrees of bony resection. The retrosigmoid, the presigmoid minimal mastoidectomy, and the retrolabyrinthine approaches were compared and yielded nearly the same exposure of the cerebellopontine angle, but the retrosigmoid approach did not provide the additional exposure of the middle fossa and petrous apex that could be achieved Βιβλιοθήκη Baidun the combined supra-and infratentorial presigmoid approach.
4
病理类型
5
部位与发病率
6
颅底脑膜瘤常见部位
7
诊断（CT）
等密度、稍高密度、钙化、囊变、出血、均 匀或者不均匀增强
8
诊断（MRI）
等T1、等T2、均一强化、脑膜尾、宽基底、 常见部位
9
诊断（DSA）
提供肿瘤供血血管方面的信息 术前栓塞减少术中出血
10
鉴别诊断
垂体瘤 神经鞘瘤 垂体瘤 脊索瘤 颅咽管瘤 室管膜瘤 脉络丛乳头状瘤