基于影像学分型的个体化手术治疗岩斜区脑膜瘤

目的 探讨依据岩斜区脑膜瘤的影像学分型进行个体化手术治疗的效果。方法 回顾性分析2010年1月~2017年12月收治的107例岩斜区脑膜瘤的临床资料。依据术前影像学分型选择手术入路:岩尖型16例中，11例颞下经天幕入路，5例岩前即Kawase入路；海绵窦型19例中，13例Kawase入路，5例乙状窦后入路，1例因累及颞下窝行Fisch颞下窝A型入路；天幕型38例中，6例颞下经天幕入路，13例乙状窦前入路，19例乙状窦后入路；上斜坡型34例中，21例乙状窦前入路，7例乙状窦后入路，4例Kawase入路，2例颞下联合乙状窦后入路。结果 16例（100%）岩尖型、38例（100%）天幕型、32例（94.1%）上斜坡型及10例（52.6%）海绵窦型达到全切除或次全切除，仅9例（47.4%）海绵窦型和2例（5.9%）上斜坡型行大部分切除。术后新发神经功能障碍27例（25.2%），无手术死亡病例。术后6个月KPS评分（77.6±11.8）分]与术前（74.3±15.0）分]无统计学差异（P>0.05）。结论 对于岩斜区脑膜瘤，依据术前影像学分型采取个体化手术入路，结合熟练的颅底解剖及娴熟的显微手术技巧，可达到最大程度切除肿瘤和尽可能减少术后神经功能障碍之间的平衡。

Individualized microsurgical treatment based on MRI classification for petroclival meningiomas

Objective To discuss the clinical effect of individualized microsurgical treatment according to the MRI classification on petroclival menigiomas. Methods The clinical data of 107 patients with petroclival menigioma who underwent microsurgery from January 2010 to December 2017 were analyzed retrospectively. The surgical approaches were selected according to the MRI classification. Of 16 patients with petrous apex type, 11 patients received subtemporal transtentorial approaches and 5 Kawase approaches. Of 19 patients with cavernous sinus type, 13 patient received Kawase approaches, 5 retrosigmoid approaches and 1 Fisch's infratemporal fossa type A approach due to the tumor involving the infratemporal fossa. Of 38 patients with tentorium type, 6 patients received subtemporal transtentorial approachs, 13 presigmoid approaches, and 19 retrosigmoid approaches. Of 34 patients with upper clivus type, 12 patients received presigmoid approaches, 7 retrosigmoid approaches, 4 Kawase approaches and 2 subtemporal combined with retrosigmoid approaches. Results The total or subtotal resection of tumor was achieved in all the patients with petrous apex type and tentorium type, and in 32 patients (94.1%) with upper clivus type and 10 (52.6%) with cavernous type. The partial resection of tumor was attained in 9 patients (47.4%) with cavernous sinus type and 2 (5.9%) with upper clivus type. No patient died from the operation. The new cranial nervous dysfunction occurred in 27 patients (25.2%) after the operation. There was no significant difference in the average KPS score 6 months after the operation (77.6±11.8) points] and before the operation (74.3±15.0) points; P>0.05]. Conclusion For petroclival menigiomas, the balance between the maximum removal of tumors and the minimization of postoperative neurological dysfunction can be reached by using the individualized microsurgical approach according to the MRI classification combined with the adept micro-operative technique and the familiar anatomy of skull base.