岩斜区脑膜瘤的显微手术入路选择和手术技巧(附23例报道)

目的探讨岩斜区脑膜瘤的手术入路选择及手术疗效。方法回顾性分析2014年11月至2015年11月手术治疗的23例岩斜区脑膜瘤的临床资料,其中颞下经天幕入路15例,枕下乙状窦后入路8例。结果肿瘤全切除17例,部分切除6例。术后发生肺部感染1例、动眼神经麻痹和面瘫3例、颞叶水肿伴出血2例。术后随访6～18个月,中位数13个月;全切肿瘤无复发,残余肿瘤无进展;末次随访KPS评分较术前明显提高(P<0.05)。结论岩斜区脑膜瘤应制定个体化的、以手术为中心结合放化疗的综合治疗方案,以病人的生存质量为导向,将提高病人的生存率的同时保证生活质量为最终目标。

Microsurgical approach selection and surgical techniques of petroclival meningioma (report of 23 cases)

Objective To investigate the choice of operative approach of petroclival meningiomas and the curative effect of microsurgery on them. Methods The clinical data of 23 patients with petroclival meningioma who underwent microsurgery from November 2014 to November 2015 were analyzed retrospectively. Of 23 patients, 15 patients were treated via subtemporal transatentorial approach and 8 via suboccipital retrosigmoid approach. Results Total resection of the tumor was achieved in 17 patients and partial resection in 6. Postopetive pulmonary infection occurred in 1 patient, oculomotor paralysis and facial paralysis in 3, and temporal lobe edema with hemorrhage in 2. The following-up ranging from 6 to 18 months (median, 13 months) showed that there was no recurrence and no progression of the residual tumors. The KPS score at the last follow-up was significantly higher than that before the operation (P<0. 05). Conclusions The comprehensive treatment of petroclival meningioma should be individualized, operation-centered, combined with radiotherapy and chemotherapy, and should be guided by patients’ quality of life. The ultimate goal is to improve the survival rate of patients and ensure the quality of life at the same time.