大型桥小脑角脑膜瘤显微手术治疗及神经功能保护

Microsurgery for Large Meningiomas of Cerebellopontine Angles and Intraoperative Preservation of Neural Function

目的探讨大型(直径>4cm)桥小脑角脑膜瘤显微外科手术切除方法以及神经功能保护效果。方法对47例经显微外科手术治疗的大型桥小脑角脑膜瘤患者的临床资料进行回顾性分析。结果47例中,行SimpsonⅠ、Ⅱ级切除40例(85.1%),部分切除7例,无手术死亡病例。面神经解剖保留率为89.4%(42/47),面神经功能(House-BrackmannⅠ、Ⅱ级)保留率为76.6%(36/47),听神经解剖保留率为83.0%(39/47),听力保留率66.0%(31/47)。结论采用枕下乙状窦后入路显微手术切除大型桥小脑角脑膜瘤安全、有效,在保留神经功能完整性的前提下应尽量切除肿瘤。

Objective To explore the for large meningiomas of cerebellopontine angles （CPA） and intraoperative preservation of neural function. Methods The clinical data of 47 patients with large meningiomas of CPA, who underwent microsurgery from July, 2000 to December, 2007, were analysed retrospectively. The comparison between the preoperative and postperative function of the nerves nearby the meningiomas of CPA was performed. Results According to Simpson resection of tumors grading, grade I resection of the tumors were achieved in 33 cases, grade H in 7 cases and part resection of the tumors were achieved in 7 cases. The rate of anatomical preservation of facial nerve was 89.4% （42/47）, and rate of its function preservation （House-Brackmann Ⅰ , Ⅱ ） was 76,6% （36/47）. The rate of anatomical preservation of auditory nerve was 83.0% （39/47）, and rate of its function preservation was 66.0% （31/ 47）. Conclusions Microsurgical resection is an effective and safe method to treat large meningiomas of CPA. The primary principles in dealing with this disease include preservation of nerve function and total resection of the tumor as possible.