经枕下乙状窦后入路切除桥小脑角脑膜瘤

目的探讨桥小脑角脑膜瘤的临床特点、手术入路及显微手术技巧。方法回顾性分析我院2010年1月~2013年11月间收治的49例桥小脑角脑膜瘤患者的临床资料。所有患者均经枕下乙状窦后入路运用显微技术切除肿瘤。结果肿瘤达SimpsonⅠ级全切除25例(51.0%),Ⅱ级切除17例(34.7%),次全切除7例(14.3%),无手术死亡。随访47例,随访时间平均2.4年(6个月~4年)。37(78.7%)例正常工作,7(14.9%)例能生活自理,3例(6.4%)生活需他人照顾。随访6个月时面听神经功能保留分别为42例(89.4%)与24例(51.1%)。结论枕下乙状窦后入路是切除桥小脑角脑膜瘤非常适宜的入路,术中结合神经电生理监测并合理运用显微技术,能够理想地切除肿瘤和提高患者生存质量。

Suboccipital Retrosigmoid Approach for Surgical Treatment of Cerebeliopontine Angle Meningiomas

Objective To investigate the clinical characteristics, operative approach and microsurgical technique on surgical intervention of cerebellopontine angle meningiomas. Methods Forty-nine cases of cerebellopontine angle meningiomas, admitted from January 2010 to November 2013, were analyzed retrospectively. All cases were treated by deploying microsurgical techniques via suboccipital retrosigmoid approach. Results In the series of the patients, tumors were achieved Simpson grade I excision in 25 cases （51.0%）, Simpson grade II in 17 cases （34.7%） and subtotal in 7 cases （ 14.3% ） without surgical mortal- ity. Forty-seven patients were followed up for 6 months to 4 years with an average of 2.4 years. During the follow-up period, 37 patients resumed work and normal life, 7 patients obtained self-care capability and 3 patients needed to be taken care of. Facial nerve and auditory nerve function were preserved in 42 cases （89.4%） and in 24 eases （51.1% ） respectively in 6 months follow-up. Conlcusions Suboecipital retrosigmoid approach is appropriate for resection of cerebellopontine angel meningiomas. Under intra-operative neurophysiological monitoring, ideal therapeutic efficacy and low disability rate could be obtained while applying microsurgical techniques to resects cerebellopontine angel meningiomas with elaborate micro-neurosurgieal skills.