显微手术治疗岩斜区脑膜瘤的临床疗效分析

目的:分析总结岩斜区脑膜瘤行显微手术治疗的临床疗效，探究影响肿瘤切除程度及术后生存质量的因素。方法:回顾性分析2015年1月至2017年12月于我院神经外科行显微手术治疗的45例岩斜区脑膜瘤患者临床资料、影像学资料及手术和随访资料。分析肿瘤全切与非全切术后并发症、新发神经功能障碍率的差异。经单因素及Logistic回归多因素探究影响肿瘤切除程度及生存质量的因素。结果:45例患者肿瘤完全切除率为64.4%，次全切除率为20.0%，部分切除率为15.6%。全切组术后并发症发生率及新发神经功能障碍率高于非全切组，但未见显著统计学差异（P＞0.05）。枕下乙状窦后入路肿瘤全切除率高，术后新发神经功能障碍率较低。肿瘤非全切患者术后行伽马刀辅助放疗，45例患者随访期均未见肿瘤复发、进展病例出现。45例患者末次随访时KPS评分较术前、术后3个月时明显提高（P＜0.05）。肿瘤大小、肿瘤质地、是否累及海绵窦、是否包绕神经血管及脑干是否水肿是影响肿瘤切除程度的独立危险因素（P＜0.05）。肿瘤质地、是否累及海绵窦、是否包绕神经血管、脑干是否水肿及肿瘤切除程度是影响患者预后KPS评分的独立危险因素（P＜0.05）。结论:显微外科手术是岩斜区脑膜瘤治疗的首选方案，但目前仍是神经外科医师面临的巨大挑战。枕下乙状窦后入路是一种安全、有效的手术入路。综合制定个体化治疗方案及选择最佳手术入路，找到肿瘤最大切除率与保护患者神经功能间的平衡点，有助于降低术后并发症及神经功能障碍率，提高患者生存质量。

Clinical analysis of microsurgical treatment of petrocline meningioma

Objective:To summarize the clinical efficacy of microsurgical treatment for petrocline meningioma,and to explore the factors of tumor resection degree and prognosis quality of life.Methods:The clinical data,imaging data,surgical and follow-up data of 45 patients with petrocline meningioma who underwent microsurgical resection in neurosurgery department of our hospital from January 2015 to December 2017 were retrospectively analyzed.To analyze the difference of complication and new nerve dysfunction rate between total tumor resection and partial tumor resection.Univariate and Logistic regression were used to explore the factors affecting the degree of tumor resection and prognosis and quality of life.Results:The total tumor resection rate was 64.4% in 45 patients,20.0% in subtotal resection rate and 15.6% in partial resection rate.The incidence of postoperative complications and the rate of newly inserted dysfunction in the total resection group were higher than that in the non-total resection group,but no significant statistics were found (P＞0.05).The total resection rate of suboccipital retrosigmoid approach was high,and the rate of new nerve dysfunction was low.Gamma knife assisted radiotherapy was given to patients with non-total tumor resection,and no tumor recurrence,progression or death was observed in all 45 patients during the follow-up period.At the last follow-up,KPS score of 45 patients was significantly higher than that before surgery and 3 months after surgery (P＜0.05).Tumor size,tumor texture,involvement of the cavernous sinus,neurovascular involvement and brain stem edema were independent risk factors for tumor resection degree (P＜0.05).Tumor texture,whether it involves the cavernous sinus,whether it wraps the nerve and blood vessels,whether it is oedema in the brain stem and the degree of tumor resection were the independent risk factors affecting the prognosis of patients with KPS score (P＜0.05).Conclusion:Microsurgery is the first choice for the treatment of petrocline meningioma,but it is still a great challenge for neurosurgeons at present.Suboccipital retrosigmoid sinus approach is a safe and effective surgical approach.Comprehensive development of individual treatment plans and selection of the best surgical approach to find the balance between the maximum tumor resection rate and the protection of patients' neurological function can help reduce postoperative complications and neurological dysfunction rate and improve patients' quality of life.