桥小脑角区脑膜瘤的分型及显微外科治疗

目的探讨桥小脑角区脑膜瘤的分型及显微外科治疗。方法回顾性分析2008年6月至2017年3月收治的76例桥小脑角区脑膜瘤的临床资料,根据术前检查及术中判断分为内听孔前型31例,内听孔后型17例,大型联合型28例。73例采用枕下乙状窦后入路,2例使用颞下入路,1例使用翼点入路。结果肿瘤全切除71例,次全切除5例。术后随访1～10年,术后新增神经症状15例,其余病人术后症状均改善;复查头颅MRI,复发3例;死亡2例。结论显微手术切除桥小脑角区脑膜瘤可获得满意效果及良好预后;扩大枕下乙状窦后入路可满足绝大多数桥小脑角区脑膜瘤切除的需要;颅神经、岩静脉及重要动脉的保护和处理在桥小脑角区脑膜瘤显微外科治疗中具有重要意义。

Classification and microsurgical treatment of cerebellopontine angle meningiomas

Objective To investigate the classification and microsurgical treatment of the cerebellopontine angle (CPA) meningiomas. Methods The clinical data of 76 patients with CPA meningiomas undergoing microsurgery from June, 2008 to March, 2017 were analyzed retrospectively. The different approaches of the microsurgery performed in the patients were selected according to the classification of CPA meningiomas. Of 76 CPA meningiomas, 31 were premeatal type tumors, 17 postmeatal type and 28 combined types according to the tumorous relationship with the internal acoustic canal. Of 76 patients with CPA meningiomas, 73 underwent microsurgery through subocipital retrosigmoid approach, 2 through subtemporal approach and 1 through pterional approach. The patients were followed up for 1 to 10 years. Results The CPA meningiomas were totally resected in 71 patients and partially in 5. Two patients died and there were new neurological dysfunctions in 15 patients during the following up. Conclusions The curative effects of microsurgery on CPA meningiomas are good. The microsurgery through the extended suboccipital retrosigmoid approach for almost CPA meningiomas is preferable. It is important to separate and protect various cranial nerves, venae petrosa and important arteries in the microsurgical operation of CPA meningiomas.