大型、巨大型岩斜区脑膜瘤显微外科入路的选择

目的 探讨大型、巨大型岩斜区脑膜瘤的显微外科治疗策略及手术入路.方法 回顾分析经显微神经外科治疗的23例大型、巨大型岩斜区脑膜瘤患者手术入路的选择和肿瘤的显露状况、切除程度及手术前后神经功能状况的变化,其中采用颞下经小脑幕一岩骨尖入路9例、经乙状窦前入路7例、经乙状窦后入路2例,经幕上下联合入路等其他术式5例,有16例手术在颅神经及脑干电生理监测下进行.结果 肿瘤全切15例(65%),次(近)全切7例(31%),大部切除1例(4%),术后新出现的颅神经损伤症状或原有症状明显加重共有16例(69%),无长期昏迷及死亡病例.结论 颞下经小脑幕-岩尖入路简便迅速、安全、损伤少而且受解剖变异影响也少,能早期切断发自幕缘的供血,直接处理肿瘤基底,术野开阔;术中颅神经及脑干电生理监测是手术成功的保障.

Microsurgical management of large and giant petroclival meningiomas

Objective To investigate the surgery strategy for large and giant petroclival meningiomas and the choice of approach.Method 23 patients treated surgically for large and giant petroelival meningiomas were retrospectively reviewed to assess the choice of operative approach,the function applyment of advanced technique equipment,the exposure of the tumor,the resection of tumor and the before-and-after-surgery perioperative condition.9 cases were conducted with subtemporal transpetrosal-ridge approach,7 with presigmoid approach,2 with retrosigmoid approach,5 with Supra-infratentorial approach and 16 with the monitoring of cranial nerves and electrophysiology technique. Results Total resection was achieved in 15 cases(65%),and subtotal in 7 cases(31%),partia in 1 case(4%).New developed CNs dysfunction and deterioration of original symptom after the operation in were found in 16 cases(69%).There were no death and long-term coma. Conclusions The subtemporal transpetrosal-ridge approach has obvious advantage.First,the approach made the surgery easy to operate,safe,swift,less damaging;it has a good universality in application;Second,it is less influenced by anatomy variation:it would cut the blood supply from the tentorium of cerebellum edge at early stage:third,its operative sight is wide and the application of micro-equipment can show the relevant structure clearly.Therefore,the application of this approach is well promoting.A successful operation will be more guranfeed by using electrophysiologic monitoring of cranial nerves and brainstem during the surgery.