枕大孔区脑膜瘤的显微手术治疗

Microsurgery on craniocervical junction meningiomas

目的报道枕大孔区脑膜瘤的显微神经外科手术的临床结果。方法选择经枕大孔后缘入路包括枕髁远外侧入路、枕下后正中入路和枕下下外侧入路,应用显微外科手术治疗的枕大孔区脑膜瘤7例,许结合文献分析影响枕大孔区脑膜瘤的手术入路的选择和影响预后的因素。结果肿瘤最大直径为0.8～4.8cm,肿瘤瘤体位置位于脑干前方3例,侧方2例,后方2例。经枕髁远外侧入路2例,枕下后正中入路3例,枕下外侧入路2例.肿瘤手术全切除6例(simpsonⅠ级4例,SimpsonⅡ级2例),次全切除1例。术后6例随访6～36个月,神经系统占位症状较术前明显好转,未见肿瘤残留和复发。结论选择合适的经忱大孔后缘的手术入路,应用显做外科手术治疗枕大孔区脑膜瘤可获得较好的临床效果。

Objective To report the microsurgical outcome of the meningiomas located in the craniocervical junction. Methods Seven cases of mcningiomas arising from the cranioccrvical junction operated with microsurgical technique by use of the posterior approaches including the suboccipital approach, the lower lateral suboccipital approach and for lateral approach. Reviewed the related articalcs and were analysed relative to their approach selection and outcomes were analysed. Results The tumors ranged in size from 0. 8 to 4. 8 cm and the tumors location with 2 cases posterior, 3 cases anterior and 2 cases lateral to the brain stem. 3 in 7 cases were operated by use of the suboccipital approach, 2 in 7 cases with the lower lateral suboccipital approach and 2 in 7 cases with farlatcral approach. Total excisions were got in 6 of 7 cases, 4 in 6 cases with Simpson grade Ⅰ and 2 in 6 cases with Ⅰ. The subtotal excision was got in 1 of 7 cass. Follow-up with 6 cases between 6 to 36 months, the occupied symptoms in 6 cases improved good. No remnant tumor and recurrent were found in the MRI follow-up. Conclusion By using of the proper posterior approaches, the microsurgical outcomes of the mcningiomas arising from cranioccrvical junction arc good.