手术治疗岩斜区脑膜瘤的策略研究

Research of surgical treatment strategy of petroclival meningiomas

目的:探讨岩斜区脑膜瘤的手术治疗策略。方法:回顾总结2007年1月至2012年6月的32例岩斜区脑膜瘤患者的临床资料、手术方式、预后及随访情况。其中颞下经小脑幕入路13例,枕下乙状窦入路19例。结果:肿瘤全切除(gross total resection,GTR)18例;近全切除(near total resection,NTR)8例;次全切除(subtotal resection,STR)(包括海绵窦区残留4例)6例;围手术期死亡1例。术后并发症主要为脑干梗塞12例(GTR组10例,NTR组2例);迟发脑内血肿18例(GTR组8例,NTR组6例,STR组4例);脑脊液漏9例(GTR组5例,NTR组2例,STR组2例)。各组并发症率为GTR组15例(83.3%);NTR组6例(75.0%);STR组4例(66.7%)。术后神经功能障碍恶化23例(71.9%),其中原有症状加重9例,新增症状者14例;神经功能障碍稳定及好转9例(28.1%)。其中GTR组15例(88.9%);NTR组5例(62.5%);STR组2例(33.3%),GTR组和非全切除组(NTR组和STR组)比较差异有统计学意义(χ2=3.94,P<0.05)。结论:追求全切除的手术策略可能增加并发症,恶化神经功能障碍,从而降低生存质量。因此手术治疗策略的选择需兼顾肿瘤全切率、术后生存质量、复发率三者之间的平衡。

Objective： To investigate petroclival meningioma surgery treatment strategy. Methods： The clinical data of 32 petroclival meningioma patients were reviewed from January 2007 to June 2012,and the data of the surgical approach,prognosis and followup cases were analysed,with 13 cases by subtemporal transtentorial approach and 19 cases by suboccipital retrosigmoid approach. Results： 18 patients were Gross total resection（ GTR）,near total resection（ NTR） for 8 patients,subtotal resection for 6 patients（ including 4 patients of cavernous sinus residues）,One case of perioperative mortality. Postoperative complications included brainstem infarction in 12 cases（ 10 cases in GTR group,2 cases in NTR group）,delayed intracerebral hematoma in 18 cases（ 8 cases in GTR group,6 cases in NTR group,4 cases in STR group）,leakage of cerebrospinal fluid in 9 cases（ 5 cases in GTR group,2 cases in NTR group,2 cases in STR group）. Complication rates in each group were GTR group of 15 patients（ 83. 3%）,NTR 6 patients（ 75. 0%）,STR 4 patients（ 66. 7%）. Postoperative neurological dysfunction worsening were 23 cases（ 71. 9%）,of which 9 cases were aggravation of symptoms,new dysfunction symptoms in 14 patients; neurological dysfunction stabilized and improved in 9 cases（ 28. 1%）,which GTR group of 16 patients（ 88. 9%）,NTR group of five cases（ 62. 5%）,STR group 2 patients（ 33. 3%）,comparing gross resection group（ GTR） and non- gross resection group（ NTR STR） difference was statistically significant（ χ^2= 3. 94,P〈0. 05）. Conclusion： Strategies of pursuing gross surgical resection may increase complications,worsen neurological dysfunction,thereby reducing the quality of life. Therefore,the option of surgical treatment strategies need to take into account the total resection rate,quality of life after surgery and recurrence rate,and find the balance among the three.