桥小脑角大型脑膜瘤的显微手术治疗

Microsurgical treatment for large and giant meningiomas of the cerebellopontine angle

目的 探讨桥小脑角大型及巨大型脑膜瘤手术入路及显微手术切除方法。 方法 回顾分析经显微手术治疗的28例桥小脑角大型及巨大型脑膜瘤。其中 19 例采用枕下乙状窦后入路,3例采用颞枕开颅乙状窦前入路,4例采用颞枕开颅颞下小脑幕入路,2 例采用颞枕开颅与幕上、下联合入路。 结果 肿瘤全切除(Simpson Ⅰ、Ⅱ级)22 例,全切除率为 78 .6%。全组无手术死亡。术后症状改善者20例,症状基本同术前5例。26例随访6个月至4年,生活自理者23 例(88 .5%),复发 2 例(7. 7%)。 结论 合理选择手术入路,术中应用显微技术妥善处理和保护血管、神经、脑干等,能较理想地切除肿瘤和提高患者生存质量。

Objective To explore the surgical approach and microsurgical technique for treating large and giant meningiomas of the cerebellopontine angle(CPA). Methods Twenty-eight patients with CPA large and giant meningiomas treated with microneurosurgery were analyzed retrospectively.19 cases were used by suboccipital retrosigmoidal approach,3 cases were used by temporal-occipital presigmoid approach,temporal-occipital subtemporal tentorial approach was used in 4 cases and temporal-occipital combined supra-infratentorial approach in 2 cases. Results Twenty-two patients received total removal (Simpson Ⅰ,Ⅱ),the total removal rate was 78.6%.No patient died after the operation.25 patients howed condition improved or persisted.26 patients were followed up for six months to four years and 23 (88.5%) patients could lived by themselves.2 (7.7%) patients developed recurrence. Conclusion It is possible to ideally remove the cerebellopontine angle tumor and inprove the patient’s life quality by choosing the adequate approach rationally,managing and protecting the vessels,nerves and brain stem carefully through microsurgical technique.