经扩大乙状窦后入路手术切除大型岩骨后脑膜瘤

目的 探讨经扩大乙状窦后入路切除大型岩骨后脑膜瘤的手术方法和治疗效果.方法 应用扩大乙状窦后入路切除16例大型岩骨后脑膜瘤,肿瘤最大径均超过4 cm,有4例肿瘤侵入岩骨,术中完全暴露横窦和乙状窦,与硬脑膜一并分别向上方和前方牵开,充分暴露小脑幕下方和岩骨背面.结果 本组肿瘤全切除15例,次全切除1例,无手术死亡,15例患者术前症状消失或改善,术后永久性面瘫1例,脑脊液漏1例.随访3个月-5年,随访期间复查MRI未见肿瘤复发.结论 经扩大乙状窦后入路切除大型岩骨后脑膜瘤具有能够早期处理肿瘤基底、有效控制术中出血、明显扩大手术暴露和提高肿瘤全切率等优点.

Surgical management of large posterior petrous meningiomas through extended retrosigmoid approach

Objective To evaluate extended retrosigmoid approach for surgery on large posterior petrous meningiomas. Methods During 5 - year period between 2004 and 2009, sixteen patients with large posterior petrous meningiomas were treateded through extended retrosigmoid approach. The maximum diameters of tumors were all more than 4 cm. The petrous bone erosion by lesions was found in 4 cases. The sigmoid sinus and the transverse sinus were thoroughly exposed after bone removal including mastoid and occipital bones. The sigmoid sinus was pulled anteriorly and the transverse sinus upward in order to widen the opening into the infratentorial space and the posterior surface of the petrous bone. Results Gross total resection of the tumors were achieved in 15 cases, subtotal resection in 1 case. There was no perioperative death. The symptoms disappeared or improved after surgery in 15 patients. There was a patient with irreversible hemifacial palsy. Cerebrospinal fluid rhinorrhea was found in one case. There was no tumor recurrence in all cases confirmed by MRI scanning during the follow - up period ( 3 to 60 months).Conclusion The extended retrosigmoid approach provides early devascularization of the tumor from its dural attachment to petrous pyramid, enhances surgical exposure and increases the complete tumor resection rate.