侵入海绵窦的岩斜脑膜瘤的手术治疗

目的 探讨侵入海绵窦的岩斜脑膜瘤的临床特点、手术策略、手术技巧和治疗效果.方法　回顾性分析2004年4月至2009年3月南昌大学第一附属医院临床资料完整的15例侵入海绵窦的岩斜脑膜瘤病例,总结其临床特点.本组均采用经乙状窦前入路,手术策略为全切除岩斜区肿瘤,对侵入海绵窦内的肿瘤行次全切除,术后辅以γ刀治疗.分析手术后颅神经功能和病人生存状况.结果头痛头晕、外展麻痹和面部麻木为本病的主要症状.手术近全切除肿瘤13例,切除≥90%2例.12例残余肿瘤术后行γ刀治疗.无手术死亡,术后无新增颅神经损害6例,出现动眼神经麻痹6例,面部麻木7例,外展功能障碍4例,面瘫7例.随访6～59个月(平均38.6个月),12例恢复正常工作和生活,2例生活自理,1例生活需他人照顾.13例无肿瘤复发,2例残余肿瘤增大者中1例经γ刀治疗肿瘤生长得到控制.眼球运动和上睑下垂均完全恢复,面瘫基本恢复,面部麻木5例部分缓解,外展功能障碍无明显改善.结论对侵人海绵窦的岩斜脑膜瘤应采用合理的手术策略,尽可能减少手术引起的神经损害,有利于提高病人的生存质量.

Surgical management of petroclival meningiomas invading into cavernous sinus

Objective To analyze the clinical features, surgical strategy and management outcomes of petroclival meningioma invading into cavernous sinus. Methods Fifteen cases with petroclival meningioma invading into cavernous sinus were retrospectively analyzed. The presigmoidal approach was selected to remove tumors. The surgical strategy for tumor in cavernous sinus was partial resection combined with radiosurgery. Postoperative cranial nerve function and patient survival status were analyzed. Results The main symptoms of subtype of petroclival meningiomas were headache, abducens nerve palsy and trigeminal neuropathy. Gross total tumor removal was achieved in 13 cases and more than 90% resection in 2 cases. There was no operative death. Nine cases suffered from new postoperative cranial nerve deficits. After a follow-up of 6-59 months, complete improvement was achieved in oculomotor nerve deficits, much improvement in Ⅶ nerve deficit, but Ⅴ and Ⅵ nerve function deficits improved slightly. The tumor progression-free survival rate was 86.7%. Conclusion Rational surgical strategy to petroclival meningiomas invading into cavernous sinus should be suggested to reduce the operative morbidity and improve the survival quality of these patients.