| Objective:To discuss the microneurosurgical technique of large and huge sphenoid ridge meningiomas(SRMs)resection via modified pterional approach.Methods:The clinical data of 32 patients with large and huge sphenoid ridge meningiomas, consecutively admitted into the Second affiliated hospital of Zhejiang University college of medicine from May 2004 to December 2007 were collected.The distribution of tumor location was 18 cases in the inner side of sphenoid ridge and 14 cases in the outside.There were 26 cases of the large SMRs and 6 of the huge.The most common complaints at presentation were headaches and visual disturbances, 68.7%of 22 cases and 37.5%of 12 cases respectively.All cases were diagnosed by CT,MRI and confirmed by histopathological findings intraoperatively.They were operated via microneurosurgery of modified pterional approach.The preoperative clinical data,the intraoperative skills and the postoperative status had been studied retrospectively.Results:Of 32 cases of SRMs,the Simpson system of the excisional degree of tumors were as follows:6 in Gradeâ… ,23 inâ…¡and 3 inâ…¢.Total removal was made in 29 patients(90.6%).There was no death during the operation.All cases were followed up from 2 to 39 months postoperatively,with the average of 22 months.It showed obvious improvement of headache in 22 cases(100%)and of vision disorder in 9(75%).Hemiparesis was found in 2 cases,and recurrence in 1.Conclusion:The large and huge SRMs can be effectively exposed and excised via microsurgery of modified pterional approach.It is very important to block up the tumor's blood supply during early period of the operation and to resect tumor piecemeally.The key technique of the operation is to separate the blood vessels and cranial nerves carefully from the tumor along the arachnoid.Resection or cauterization and reparation of the cerebral dura mater attached with tumor are significant to depress the recurrence and complication at post-operation. |
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