远外侧入路切除枕骨大孔区腹侧及腹外侧脑膜瘤的显微手术探讨(附11例报告)

目的探讨经远外侧入路切除枕骨大孔区腹侧及腹外侧脑膜瘤的显微手术技巧。方法自2003年5月至2010年5月经远外侧入路显微手术切除枕骨大孔区腹侧及腹外侧脑膜瘤11例,其中,经枕髁后入路5例,经部分枕髁入路4例,经C_1～2关节面侧方联合部分枕髁入路2例。结果肿瘤全切除（SimpsonⅠ、Ⅱ级）7例,次全切除（SimpsonⅢ级）3例,大部切除（SimpsonⅣ级）1例,无手术死亡病例。结论经远外侧入路显微手术切除枕骨大孔区腹侧及腹外侧脑膜瘤的关键在于:①合理设计磨除枕骨大孔侧方骨质的范围以充分暴露肿瘤;②术中注意保护脑干、上颈髓、后组颅神经及椎动脉等重要结构。

Microsurgery through far-lateral suboccipital approach for meningiomas located in the ventral and ventrolateral regions of the foramen magnum(report of 11 cases)

Objective To explore the skill of microsurgery through the far-lateral suboccipital approach for meningiomas located in the ventral and ventrolateral regions of the foramen magnum.Methods Of 11 patients with meningiomas located in the ventral and ventrolateral regions of the foramen magnum treated in our department from May 2003 to May 2010,5 underwent microsurgery through the retrocondylar approach,4 through the partial transcondylar approach,and 2 through the C₁ ～C₂ lateral approach combined the partial transcondylar approach.Results Total removal of the tumors was achieved in 7 patients,subtotal removal in 3 patients and most removal in 1 patient.No patients died.Conclusions The key points of microsurgery through the far-lateral approach for meningiomas located in the ventral and ventrolateral regions of the foramen magnum include abrading the bone lateral to the foramen magnum enough to fully expose the tumor and protecting the important structures such as the brainstem,upper cervical spinal cord,cranial nerves and so on.