岩斜坡脑膜瘤的显微外科治疗

目的通过总结本病的放射学特点、手术入路和治疗效果,以探讨岩斜坡脑膜瘤的手术策略和如何改善手术效果。方法回顾性分析21例岩斜坡脑膜瘤,采用3种手术入路显微外科治疗,包括(1)经岩骨-天幕入路3例;(2)乳突后枕下入路15例;(3)远外侧枕下入路3例。结果术后恢复良好者19例(90.5%),经术后CT或MR证实肿瘤全切除者13例(62%),无手术死亡。术后新增颅神经损害10例(47%),其中永久性损害3例(14%)。肿瘤巨大、肿瘤血管化或纤维化、脑干与肿瘤之间的蛛网膜界面消失、基底动脉供血等因素增加手术困难,影响术后效果。结论采用合适的手术入路和精良的显微外科技术可以提高岩斜坡脑膜瘤的全切除率,降低残死率。但保证病人术后生存质量是最重要的手术目的,当肿瘤巨大或蛛网膜界面消失时,全切除肿瘤会十分困难,应考虑次全切除肿瘤,术后用γ-刀处理残余肿瘤。

Microsurgical management of petroclival meningiomas

Objective We reviewed the radiological features,operative approaches,microsurgical technique and results in cases of petroclival meningiomas, in order to probe the operative strategy and to improve operative results. Methods 21 cases with petroclival meningiomas operated by 3 types of operative approach were analyzed retrospectively. The following 3 types of operative approach were used including( 1) a transpetrosal and tentorial approach in 3 cases; (2) a suboc-cipital retromastoid approach in 15 cases; (3) a far lateral suboccipital approach in 3 cases. Rusults There were good postoperative recovery in 19 patients (95 .5% ), total excision documented by postoperative CT scans or MR in 13 patients (62%) and without operative death. Postoperatively, new cranial nerve deficits occurred in 10 patients (47%), of which there was permanent worsening of cranial nerve function in 3 cases (14% ) . Intraoperative technical difficulties such as tumor consistency, vascularity,losing an arachnoidal plane of dissection from the brain stem,and vascular and cranial nerve encasement may affect outcome. Conclusions The appropriate cranial base approaches and excellent microsurgical technique could raise total removal rate, and decrease mortality and morbidity. The most important goal of surgical resection lies in good postoperative result, therefore, the subtotal removal of tumor and gamma knife therapy of residual tumor should be considered when the tumor is large or the arachnoidal dissecting plane is lost.