显微手术治疗枕大孔区脑膜瘤

Microsurgical treatment of foramen magnum meningiomas

目的探讨枕大孔区脑膜瘤临床特征、手术入路及围手术期管理。方法回顾性分析114例枕大孔区脑膜瘤患者的临床特仟、治疗及预后。结果枕颈部不适及疼痛和头痛头晕是最常见的起病症状，从出现症状到就诊平均病程11．7个月，术前KPS评分72．5±8．3。腹侧型24例，腹外侧型80例，背外侧型10例。肿瘤平均最大径为（33．5±5．6）mm。10例采用枕下后正中入路，97例采用远外侧经髁或髁后入路，7例采用扩大远外侧入路。肿瘤全切98例，近全切除及大部切除16例，死亡率1．8％。随访到93例，平均随访90．3个月，59例正常生活（63．4％）。结论大多数腹侧和腹外侧型的枕大孔区脑膜瘤可采用远外侧经髁或髁后入路，力求第一次手术全切肿瘤，术后应加强管理。

Objective To report the clinical and radiological features as well as the surgical findings and outcomes for foramen magnum meningiomas （ FFM ） patients treated in the department of neurosurgery in Beijing Tiantan hospital over the last 15 years. Methods 114 consecutive cases of FFM operated between May 1993 and June 2008 were reviewed and followed up. Results Cervico - occipital pain （80. 7% ）, headache and dizziness （42. 1% ） were the most common symptoms. The mean duration of preoperative process was 11.7 months. The preoperative KPS was 72. 5 ±8. 3. All the FFMs were classified as anterior （80 cases） , anterolateral （24 cases） and posterolateral （10 cases） types. The mean maximum diameter of tumors on MRI was （3.35±5.6 ）era. The posterior midline approach was performed in 10 cases, far - lateral transcondylar or retrocondylar approach in 97 cases and extended far - lateral approach in 7 cases. Gross total resection was achieved in 86. 0% of patients, and subtotal resection in 14. 0%. Surgical mortality was 1.8%. Follow - up data were available for 93 patients, with a mean follow - up duration of 90.3 months （from 1 to 180 months）. 59 （63.4%） patients lived a normal life （KPS, 80 -100）. Conclusions Most anterior and anteriolateral FFMs can be completely resected by farlateral transcondylar or retrocondylar approach. Total removal of tumors should be attempted to achieved at the first operation. Postoperative management of FFM is important for prognosis.