手术治疗岩斜区脑膜瘤

Surgical treatment of petroclival meningioma

目的 提高岩斜区脑膜瘤的切除程度与术后疗效。方法 回顾性分析 2 2例岩斜区脑膜瘤的临床资料。结果 全组病例获肿瘤全切除者 12例 ,肿瘤次全切除 6例 ,肿瘤大部切除 4例 ;其中经乙状窦前入路手术治疗的 11例中 ,获全肿瘤切除者 8例 ,次全肿瘤切除 2例 ,肿瘤大部切除 1例。结论 岩斜区脑膜瘤宜行积极手术治疗 ;乙状窦前入路是目前手术治疗岩斜区脑膜瘤的最佳入路 ;掌握手术方法和术中注意事项 ,有利于提高肿瘤切除程度和术后疗效 ;肿瘤大小、质地及其与邻近结构的相互关系 ,也是影响岩斜区脑膜瘤患者术后疗效的重要因素。

Objective To raise the removal degree and to improve the postoperative result of the petroclival meningioma, its surgical strategy, the approach and the technique were probed and the factors affecting curative effect were analyzed. Methods The clinical data of consecutive 22 patients with the tumors, treated from Jan. 1989 to June 2000 in our department, were reviewed. Results Of all patients in this group, total tumor removal was achieved in 12 patients, subtotal in 6 and largely partial in 4, the cranial nerve deficit postoperatively took place in 11 patients. Of 11 patients who underwent surgical treatment via presigmoid sinus approach, total tumor removal was achieved in 8 patients, subtotal in 2 and largely partial in 1, the cranial nerve deficit postoperatively took place in 5 patients. Conclusions The petroclival meningioma is suitable for aggressive surgical treatment. The presigmoid sinus approach so far is optimal for surgical treatment petroclival meningioma. It has such advantage as shorter access, clearer exposure and more convenience to early devascularization of the tumor etc. The tumor was first cored after its devascularization. After sufficient decompression, the peripheral portion of the tumor was dissected to free the surrounding structures along the right interface, and then removed. The most important microsurgical technique is conducive to raising the removal degree and the postoperative curative effect of the tumor, and decreasing the cranial nerve deficit. Tumor size and texture, and correlation of it with adjacent structure are also the important factors affecting the curative effect of the patient with the tumor.