大型、巨大型岩斜区脑膜瘤的显微外科治疗

Microsurgery for large and giant petroclival meningioma

目的探讨岩斜区脑膜瘤的手术切除程度，总结显微外科手术经验。方法回顾性分析26例大型、巨大型岩斜区脑膜瘤患者的临床资料，采用显微外科手术切除肿瘤，其中颞下经小脑幕入路7例，枕下乙状窦后入路15例，幕上、下联合入路（颞下入路联合乙状窦后入路）2例，眶颧入路2例。结果肿瘤全切（SimpsonⅠ、Ⅱ级）13例，次全切（SimpsonⅢ级）4例，大部切除（SimpsonⅣ级）9例。结论追求肿瘤最大程度地切除并尽可能减少术后并发症的发生，根据肿瘤大小、生长方式、侵犯区域等因素个体化选择不同的手术入路。

Objective To summarize the experience of microsurgical removal of large and giant petroclival meningiomas. Methods The clinical data of 26 patients of large or giant petroclival meningiomas were collected. 7 cases were conducted through subtemporal transpetrosal approach, 15 retrosigmoid,2 supra - infratentorial （subtemporal and retrosigmoid sinus combined approach ） and 2 orbitozygomatic approach. Results Gross total resection （ Simpson Grade I or II ） was achieved in 13 patients, subtotal resection （ Simpson Grade III ） in 4, and partial resection （ Simpson Grade IV ） in 9. Conclusions To avoid blind pursuing total resection of tumors, and to.seek to the balance between the extent of tumor resection and reducing postoperative complications, different surgical approaches should be chosen according to the types, size, growth patterns and encroachment areas of large and giant petroclival meningiomas.