岩斜区脑膜瘤颅底侵袭的半定量分析及手术入路选择:66例报告

Semi-quantitative analysis of skull base invasion and selection of surgical approaches of petroclival meningiomas: a report of 66 cases

目的半定量分析岩斜区脑膜瘤(PCM)的颅底侵袭范围,选择相应手术入路并评估手术效果。方法评估66例PCM的影像学特点,将其颅底侵袭范围分为5个分区:上、中、下岩斜区(A、B、C区),桥小脑角区(D区)和鞍旁-海绵窦区(E区)。根据分区结果选择颞下入路11例,乙状窦后入路15例,乙状窦前入路32例,乙状窦后+远外侧联合入路2例,幕上下联合入路4例及扩大中颅窝底入路2例。结果术前MRI显示最常受累的颅底区域为A、B、E区(分别占97.0%、75.8%和59.1%)。单个分区受累仅占7.6%,绝大多数PCM倾向于侵袭多个分区。肿瘤全切除29例,次全切除27例,大部分切除10例。随访40例,平均随访32.21个月;7例患者遗留明显颅神经功能障碍,肿瘤复发8例。结论半定量分析PCM的颅底侵袭程度,便于对PCM进行分类并选择合适的手术入路。术前详细评估并慎重选择手术入路,可改善患者预后,提高手术效果。

Objective The tumor extension of petroclival meningiomas （PCMs） was discussed by semiquantitative analysis to choose and evaluate the outcomes. Methods Clinical data of 66 eases of PCMs were collected and analyzed retrospectively. According to neuroimaging evaluation, skull base related to tumors was divided into 5 regions semi-quantitatively： upper, middle and lower petroclival regions （region A, B and C, respectively）, cerebellopontine angle region （region D） and parasellar and cavernous sinus region （region E）. According to different degrees of skull base invasion, the corresponding surgical approaches were chosen, including the subtemporal （11 cases）, retrosigmoid （15 cases）, presigmoid （32 cases）, combined retrosigmoid and far-lateral （2 cases）, supra-infratentorial （4 cases ） and extended middle cranial fessa （2 cases ） approaches. Results Pre-operative MRI indicating that region A, B and C were the most commonly involved （97.0%, 75.8% and 59. 1%, respectively）. Single region involvement occurred in only 7. 6% of the cases, whereas most PCMs tended to invade two or more regions. Gross total resection was achieved in 29 cases, near total resection in 27 cases and subtotal resection in 10 cases. After a mean follow-up period of 32. 21 months for 40 patients, obvious cranial nerve deficits existed in 7 cases, and recurrence occurred in 8 cases. Conclusion Semi-quantitative analysis of skull base tumor invasion can help to classify PCMs conveniently, thereby selecting the appropriate surgical approaches. With careful pre-operative evaluation, a cautiously selected approach would improve the prognosis.