岩斜区脑膜瘤的临床治疗

目的探讨岩斜区脑膜瘤的手术切除程度、手术人路选择及放射治疗的应用。方法回顾性分析51例岩斜区脑膜瘤病人的临床资料，根据肿瘤大小、累及部位及病人的状态等选择手术人路，行颞下经小脑幕入路31例，乙状窦前人路3例，枕下乙状窦后入路17例。结果术后肿瘤SimpsonⅠ-Ⅱ级切除40例，SimpsonⅢ级切除9例，SimpsonⅣ级切除2例；SimpsonⅢ-Ⅳ级切除病人术后接受放射治疗。术后出现昏迷8例，面神经麻痹7例，肢体肌力下降11例，动眼神经麻痹15例，展神经麻痹5例．颅内感染3例；死亡1例。50例随访6-18个月，术前症状及术后并发症大部分不同程度改善，随访期内无肿瘤复发及残余肿瘤进展。结论手术全切除是岩斜区脑膜瘤的根治方法，但片面追求肿瘤全切除常产生严重并发症。术前应根据病人的综合情况为其选择个性化的手术人路。选择SimpsonⅢ-Ⅳ级切除可提高病人的生活质量，术后辅助放射治疗能有效控制残余肿瘤进展，降低肿瘤复发率。

Clinical therapy of petroclival meningiomas

ObjectiVe To investigate the extent of tumor resection, choice of surgical approach and application of the radiotherapy for petroelival meningiomas. Methods Clinical data of 51 patients with petroclival meningiomas were analyzed retrospectively. The surgical approach was chosen according to the size, location and extension of the tumor and the condition of patients, including subtemporal transtentorial approach in 31 patients, presigmoid approach in 3 and suboccipital-retrosigmoid approach in 17. Results The tumor resection with Simpson grade Ⅰ or Ⅱ was achieved in 40 patients, Simpson grade Ⅲ section in 9 and Simpson grade Ⅳ section in 2. The patients with Simpson grade Ⅲ or Ⅳ resection were underwent radiotherapy after the operation. The complications occurred after the operation, including coma in 8 patients, facial nerve palsy in 7, limb muscle strength decline in 11, oculomotor nerve palsy in 15, abducent nerve palsy in 5 and intracranial infection in 3. One patient died after the operation. Fifty patients were followed up for 6 to 18 months, most preoperative symptoms and postoperative complications were improved to different degree, and no tumor recurrence or residual tumor progression was seen during the follow-up period. Conclusions Total tumor removal is a radical treatment for petroclival meningiomas, however, it usually leads to serious complications. The individualized surgical approach should be chosen for each patient according to the comprehensive situation of patients before the operation. Simpson grade Ⅲ to Ⅳ resection can improve the quality-of-life for patients, and postoperative radiotherapy can control the residual tumor growth and effectively reduce the tumor recurrence.