Kawase入路手术切除岩斜区脑膜瘤的疗效分析

目的 探讨Kawase入路手术切除岩斜区脑膜瘤的疗效。方法 回顾性分析2012年4月至2019年12月经Kawase入路手术治疗的57例岩斜区脑膜瘤的临床资料。结果 根据Kawase分型标准:上斜坡型15例，海绵窦型10例，小脑幕型23例，岩尖型9例。Simpson分级Ⅰ~Ⅱ级切除42例，Ⅲ~Ⅳ级15例。术后新发颅神经损伤6例，颅内感染2例，迟发性颅内血肿1例，脑脊液漏2例。57例中位随访时间为28个月；末次随访，症状明显改善19例（33.3%），改善32例（56.1%），无改善或恶化2例（3.5%）。Simpson分级Ⅰ~Ⅱ级42例中位随访时间为26个月，肿瘤复发2例（3.5%）；Ⅲ~Ⅳ级15例中位随访时间为31个月，8例（53.3%）复发，1例术后17个月死亡。结论 岩斜区脑膜瘤解剖结构复杂，手术难度大，采用Kawase入路，根据Kawase分型标准，应用不同的手术策略，可取得良好的疗效。

Outcomes of microsurgical resection through Kawase approach for petroclival meningiomas

Objective To investigate the clinical efficacy of microsurgical resection through Kawase approach for the petroclival meningiomas. Methods The clinical data of 57 patients with petroclival meningioma who underwent microsurgical resection through Kawase approach from April 2012 to December 2019 were retrospectively analyzed. Results According to Kawase classification criteria, 15 patients were classified as upper clivus type, 10 cavernous sinus type, 23 tentorium type, and 9 petrous apex type. Simpson grade Ⅰ~Ⅱ resection was achieved in 42 patients and grade Ⅲ~Ⅳ in 15. New cranial nerve injury occurred in 6 patients, intracranial infections in 2, delayed intracranial hematoma in 1 and cerebrospinal fluid leakage in 2. The median follow-up period of the 57 patients was 28 months. At the last follow-up, the symptoms improved significantly in 19 patients (33.3%), improved in 32 patients (56.1%), and did nor change or worse in 2 patients. The median follow-up time of 42 patients undergoning Simpson Ⅰ~Ⅱ resection was 26 months, and 2 patients recurred. The median follow-up time of 15 patients (26.3%) undergoning Simpson Ⅲ~Ⅳ resection was 31 months, 8 patients (53.3% patients) recurred, and 1 died 17 months after surgery. Conclusions The anatomical structure of meningioma is complicated and complete resection of tumor is difficult. Microsurgical resection through Kawase approach can obtain good outcomes by using different surgical strategies according to Kawase classification criteria.