不同岩斜区脑膜瘤手术入路的疗效分析

目的探讨岩斜区脑膜瘤采用不同手术入路的治疗效果。 方法回顾性分析中山大学附属第一医院神经外科自2013年6月至2020年6月收治的76例岩斜区脑膜瘤患者的临床资料，分析其临床表现、手术效果，同时对不同手术入路的手术效果和并发症进行比较。 结果76例岩斜区脑膜瘤，肿瘤全切除42例（55.3%），次全切除28例（36.8%），部分切除6例（7.9%）。术后病理提示世界卫生组织（WHO）Ⅰ级脑膜瘤71例（93.4%），WHOⅡ级脑膜瘤5例（6.6%）。术后颅神经受损26例，脑干受损2例，脑脊液漏4例，颅内感染5例。术前平均卡氏功能状态（KPS）评分为（73.6±8.7）分，术后6个月平均KPS评分为（79.7±8.8）分，术后6个月平均KPS评分高于术前（P<0.05）。对不同入路而言，颞下组全切率高于乙状窦后组（P<0.05），但术中出血量多于乙状窦后组（P<0.05）。 结论岩斜区脑膜瘤大多为良性肿瘤，且多数岩斜脑膜瘤可以获得全切除或次全切除。颞下入路全切率高，但术中出血多于乙状窦后入路。

Effect analysis of different surgical approaches for petroclival meningiomas

ObjectiveTo investigate the efficacy of microsurgery on petroclival meningiomas. MethodsThe clinical data of 76 patients with petroclival meningioma admitted to the Department of Neurosurgery, the First Affiliated Hospital of Sun Yat-Sen University from June 2013 to June 2020 were retrospectively analyzed. The effects and complications of different surgical approaches were compared. ResultsAmong 76 cases of petroclival meningiomas, 42 cases (55.3%) were totally resected, 28 cases (36.8%) were subtotally resected, and 6 cases (7.9%) were partially resected. Postoperative pathology showed 71 (93.4%) WHO grade Ⅰ meningiomas and 5 (6.6%) WHO grade Ⅱ meningiomas. The sugical complication included 26 cases of cranial nerve injury, 2 cases of brain stem injury, 4 cases of cerebrospinal fluid leakage and 5 cases of intracranial infection. The average preoperative Karnofsky performance status (KPS) score was 73.6±8.7. The average KPS score at 6 months after operation was 79.7±8.8. The average KPS score at 6 months after operation was better than that pre-operation (P<0.05). For different approaches, the intraoperative blood loss in the infratemporal group was more than that in the retrosigmoid group (P<0.05), and the total resection rate was higher than that in the retrosigmoid group (P<0.05). ConclusionMost of petroclival meningiomas are benign tumors. Most of petroclival meningiomas can be totally or subtotally removed by careful microsurgery. Although the intraoperative blood loss of infratemporal approach was more than that of retrosigmoid approach, the total resection rate was higher.