大型及巨大型岩斜区脑膜瘤的显微外科治疗

目的 总结大型及巨大型岩斜区脑膜瘤的治疗经验.方法 根据临床表现和影像学特征,将41例大型及巨大型岩斜区脑膜瘤分为3组:Ⅰ组(肿瘤位于上斜坡,18例)、Ⅱ组(肿瘤位于中下斜坡,17例)、Ⅲ组(肿瘤累及全斜坡,6例).Ⅰ组肿瘤采用颞枕下经小脑幕入路,Ⅱ组肿瘤采用枕下乙状窦后入路,Ⅲ组肿瘤采用幕上下联合入路切除岩斜区脑膜瘤.结果 肿瘤切除Simpson Ⅰ～Ⅱ级Ⅰ组7例,Ⅱ组7例;Ⅲ级切除Ⅰ组8例,Ⅱ组8例,Ⅲ组2例;Ⅳ级切除Ⅰ组3例,Ⅱ组2例,Ⅲ组2例.Ⅲ组病人死亡2例.结论 对于不同类型的大型及巨大型岩斜区脑膜瘤,选择不同的手术方式,对提高术后疗效和减少手术并发症有重要作用.

Microsurgery for large and giant petroclival meningioma

Objective To summarize the experience of treating large and giant petroclival meningioma.Methods According to the clinical features and imaging characteristics,41 cases with large and giant petroclival meningioma were divided into three groups：group Ⅰ（tumors being located in the upper clivus,n=18）,groupⅡ（tumors being located in the middle and lower clivus,n=17） and group Ⅲ（tumors being involved in the whole clivus,n=6）.The tumors were resected via subtemporal transtentorial approach in group Ⅰ,via retrosigmoid suboccipital approach in group Ⅱand via combined supratentorial-infratentorial approach in group Ⅲ.Results Simpson Grade I or Ⅱ resection was achieved in 7 cases in group Ⅰ and groupⅡeach;Simpson Grade Ⅲ resection was achieved in 8 cases in group Ⅰ,8 cases in groupⅡ and 2 in group Ⅲ;Simpson Grade Ⅳ resection was achieved in 3 cases in group Ⅰ,2 cases in groupⅡ and 2 in group Ⅲ.Two patients died in group Ⅲ.Conclusion Different surgical approaches should be chosen according to different kinds of large and giant petroclival meningioma,which is important for increasing therapeutic efficacy and reducing postoperative complications.