枕下乙状窦后-内听道上入路显微手术切除岩斜区脑膜瘤

目的 探讨经枕下乙状窦后.内听道上入路(TSRSA)显微手术切除岩斜区脑膜瘤的手术方法、经验和技巧,以提高手术全切率与改善预后.方法 回顾性分析TSRSA显微手术切除23例岩斜区脑膜瘤的临床资料.肿瘤主体均位于后颅窝,其最大直径在1.8～5.7cm(平均3.9cm).对手术方法和经验进行分析和总结,并对该手术入路的适应证和优缺点进行分析.结果 肿瘤全切19例(83%),次全切除4例(17%),术后新增脑神经损害3例(13%),术后并发中脑出血1例,皮下积液1例,无手术相关死亡病例及其他并发症.结论 TSRSA适用于主体在后颅窝的Ⅱ型岩斜区脑膜瘤.采用该入路处理岩斜区脑膜瘤,通过磨除内听道上结节和岩尖,有利于提高肿瘤的全切率和术后疗效,降低脑神经损伤的发生率.

Microsurgical resection of petroclival meningiomas by trans-suboccipital retrosigmoid suprameatal approach

Objective To study the removal technique and operative experience in the microsurgieal resection of petroclival meningiomas by trans-suboccipital retresigmoid suprameatal approach ( TSRSA), to improve the rote of total resection of tumors and the postoperative results. Methods The consecutive twenty-three eases of petroclival meningiomas treated from Jan. 2003 to Jun. 2007 by microsurgical technique using standard TSRSA were reviewed retrospectively. The maximum diameter of the tumors ranged from 1.8 to 5.7 cm ( mean 3.9cm). The main parts of all tumors were located in posterior fossa. The tumor control rate, postoperative neurological deficit and functional status were assessed by Kamofsky Performance Score (KIXS) to evaluate the indications, advantages and disadvantages of TSRSA. Results The gross total tumor resection was achieved in 19 patients (83%) ,subtotal in 4 cases( 17% ). The new functional deficit of cranial nerves were found in 3 patients ( 13% ). There was no mortality with relation to operation or decrease in KPS was observed at the discharge. One case was complicated by midbrain hemorrhage, one ease with subcutaneous hydrocele. Conclusion This approach is suitable for petroclival meningiomas mainly in posterior fossa with extension to middle fossa (type Ⅱ ) to improve the rate of total resection of tumors and the postoperative results, and to decrease the postoperative functional deficit of cranial nerves.