“双镜联合”显微神经外科手术治疗桥小脑角脑膜瘤

目的探讨神经内镜和显微镜“双镜联合”下显微神经外科手术治疗桥小脑角脑膜瘤的临床应用价值及优势。方法回顾性分析经枕下乙状窦后入路显微神经外科手术治疗的39例桥小脑角脑膜瘤患者的临床资料。其中11例患者为“双镜联合”下手术切除肿瘤(双镜联合组),28例患者为单纯显微镜下手术切除肿瘤(显微镜组)。结果双镜联合组患者中肿瘤全切除(SimpsonⅠ-Ⅱ级)者9例,近全切除2例,肿瘤全切率为81.8%。显微镜组患者中肿瘤全切除(SimpsonⅠ-Ⅱ级)者19例,近全切除5例,大部切除4例,肿瘤全切率为67.9%。两组患者的面神经均解剖保留。内听道前后型脑膜瘤患者的面神经功能保留率,双镜联合组患者为71.4%,显微镜组患者为66.7%。结论“双镜联合”手术是治疗桥小脑角脑膜瘤的有效方法,特别是对于处理长入内听道或蔓延至幕上的桥小脑角脑膜瘤有较大的优势。神经内镜和显微镜的“双镜联合”手术能够互补不足,并充分发挥各自的优势;从而提高肿瘤全切除率,减少神经功能损伤发生率。

Combination of neuroendoscope and microscope in microsurgical treatment of cerebellopontine angle meningiomas

Objective To explore the clinical application value and advantages of microsurgical neurosurgery in the treatment of cerebellopontine meningiomas under the“microscopic-endoscopic combination”.Methods The clinical data of 39 patients with cerebellopontine angle meningioma treated by microsurgery via suboccipital retrosigmoid approach were retrospectively analyzed.Among them,11 cases were treated by“microscopic-endoscopic combined”operation(microscopic-endoscopic combined group),and 28 cases were treated by simple microscope operation(microscope group).Results In the microscopic-endoscopic combined group,there were 9 cases of simpson grade Ⅰ and Ⅱ resection,and 2 cases of near total resection.The total tumor removal(simpson grade Ⅰ and Ⅱ)was achieved in 81.8%.In the microscope group,there were 19 cases of simpson grade Ⅰ and Ⅱ resection,5 cases of near total resection,and 4 cases of partial resection.The total tumor removal(simpson grade Ⅰ and Ⅱ)was achieved in 67.9%.The anatomical preservation of the facial nerve was achieved in both groups of cases.For the meningiomas showed involvement of the internal auditory canal(IAC),and were located anterior or posterior to the IAC,the facial nerve function preservation rate in the microscopic-endoscopic combined group was 71.4%,and the facial nerve function preservation rate in the microscope group was 66.7%.Conclusions“Microscopic-endoscopic combined”operation mode is an effective treatment method for cerebellopontine meningiomas,especially for the treatment of cerebellopontine meningiomas that grow into the IAC or extend into the tentorium.The combination of neuroendoscopy and microscopy can complement each other,improve the rate of total tumor removal,and reduce nerve function damage.