1. 教 师 : 罗 林 教授 昆明医学院第三附属医院神经外科 Meningioma

2.  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.

3.  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.

5.  Diagnosis :  Olfactory groove meningioma

6. Incidence Common site Clinical manifestation Examination Diagnosis Treatment

7.  Most of meningiomas come from the cell of arachnoid.

8. Incidence A very common condition with a variety of causes. The second most commonly. More commonly seen in female, a ratio of 2:1

9. 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）

10. The most common site  Sagittal sinus  Tuberculum sellae  Plate of ethmoid  Cavernous sinus  Pons-cerebellum angle (CPA)  Tentorium of cerebellum

11. Sagittal sinus

12. Tuberculum sellae

13. Plate of ethmoid

14. Pons-cerebellum angle (CPA)

15. Tentorium of cerebellum

16. 材料与方法 Clinical manifestation

17.  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。

18. Special examination

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

20. cerebral angiography

23. Diagnosis

24. 1. Clinical manifestation 2. Special examination

26. 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。

27.  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

28.  1.opertaion  2.radiotherapy (γ-knief X-knief)  3.others

29. GradeDescription 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