岩斜区脑膜瘤的显微手术治疗

Microsurgical management of petroclival meningiomas

目的探讨岩斜区脑膜瘤显微手术的治疗效果。方法对21例行显微手术治疗的岩斜脑膜瘤患者f采用枕下乙状窦后入路3例，幕上下经岩骨乙状窦前入路18例）的临床资料及手术效果进行分析。结果肿瘤获全切（SimpsonI、Ⅱ）11例，次全切（SimpsonⅢ）5例，大部分切除4例，部分切除1例。术后死亡1例。术后早期出现动眼神经瘫5例，面神经功能障碍4例，后组神经瘫2例，对侧肢体轻瘫2例。术后随访3个月～4年，3例不完全动眼神经瘫1个月后恢复，2例完全损伤未恢复：4例面神经功能障碍中3例3个月后恢复．1例未恢复：2例后组神经瘫术后1周全恢复；2例对侧肢体功能障碍，术后1个月恢复。5例患者术后行Y刀治疗。没有病例出现术后复发。结论岩斜区脑膜瘤手术入路的选择是关键，乙状窦前入路是目前最有效的手术入路。

Objective To explore the efficacy of microsurgery on petroclival meningiomas. Methods A retrospective analysis of the clinical data and the prognosis of microsurgery was performed on 21 patients with petroclival meningioma. Suboccipital retrosigmoid approach was adopted in 3 and supraor infi＇a-tentorial transpetrosal presigmoid approach was adopted in 18. The clinical manifestations and surgical outcomes were analyzed to evaluate the significance of microsurgery. Results Of the 21 patients with petroclival meningioma, total resection （Simpson I , Ⅱ ） and sub-total resection （Simpson Ⅲ ） were achieved in 11 and 5, respectively; resection of major part was obtained in 4 and partial resection was obtained in 1 with I postoperative death. At the early stage of postoperation, 5 patients developed oculomotor palsy and 4 developed dysfunction of facial nerve; 2 were found caudal cranial nerve palsy and 2 were found hemiplegia contralateral to the tumor. All these patients were followed up for about 3 months to 4 years： 3 recovered from the oculomotor palsy 1 month after the operation and 3 recovered from the dysfunction of facial nerve 3 months after the operation; 2 recovered from caudal cranial nerve palsy 1 week after the operation and 2 recovered from hemiplegia 1 month after the operation. 5 were performed y knife radiotherapy without tumor recurrence. Conclusion Choosing the right approach is the key to petroclival meningiomas management and presigmoid approach is the most effective way at present.