颞下-乙状窦后联合锁孔入路显微手术治疗岩斜区巨大脑膜瘤临床观察

目的探讨应用颞下-乙状窦后联合锁孔入路显微手术治疗岩斜区大型、巨大型脑膜瘤的手术方法及疗效。方法回顾性分析采用颞下-乙状窦后联合锁孔入路显微手术治疗的24例大型、巨大型岩斜区脑膜瘤患者的临床资料,总结手术经验和临床疗效。结果 24例患者肿瘤全切除(SimpsonⅠ、Ⅱ级)20例(83.3%),次全切除(SimpsonⅢ级)4例(16.7%)。术后新增神经功能障碍7例(29.2%),出现脑干出血1例(4.2%),脑干梗死1例(4.2%),脑脊液漏1例(4.2%),颅内感染1例(4.2%),肺部感染2例(8.3%)。无围手术期死亡病例。术后随访3~59个月,无肿瘤复发或残余肿瘤明显进展。结论对于中后颅窝和(或)幕上下骑跨的大型、巨大型岩斜区脑膜瘤,采用颞下-乙状窦后联合锁孔入路进行显微手术切除是一种安全有效的治疗方式。

Microsurgical treatment of large and giant petroclival meningiomas via combined Subtemporal and retrosigmoid keyhole approach

Objective To study the method and effect of microsurgical treatment of large and giant petroclival meningiomas via combined subtemporal and retrosigmoid keyhole approach.Methods The clinical data in a consecutive series of 24 patients with large and giant petroclival meningiomas who had received microsurgical treatment was analyzed retrospectively.These patients were treated via combined subtemporal and retrosigmoid keyhole approach.The technique of combined keyhole approach, the effect of clinical treatment and the quality of post-operative life were analyzed.Results The gross total resection (Simpson GradeⅠand Ⅱ)was achieved in 20 cases (83.3％).The subtotal resection (Simpson GradeⅢ)was achieved in 4 cases (16.7％). New-onset post-operative neurological dysfunction appeared in 7 cases (29.2％).The post-operative complications included brain stem hemorrhage in 1 case (4.2％),brain stem infarction in 1 case (4.2％),cerebrospinal fluid leakage in 1 case (4.2％),intracra-nial infection in 1 case (4.2％),and pulmonary infection in 2 cases (8.3％).There was no death during perioperative period.The post-operative follow-up period ranged from 3 to 59 months,and there was no tumor recurrence or progress.Conclusion The combined subtemporal and retrosigmoid keyhole approach is a safe and effective approach for microsurgical treatment of large and giant petroclival meningiomas.