岩斜区脑膜瘤术中外展神经的保护

Protection of abducent nerve in the operation of petroclival meningioma

目的总结30例岩斜区脑膜瘤手术患者的临床资料,以期提高岩斜区脑膜瘤的切除程度,并降低外展神经的损伤。方法总结30例岩斜脑膜瘤的临床特点、手术经验及外展神经受损情况,探讨Dorello＇s管区病理解剖特点与岩斜区脑膜瘤的关系。结果 30例岩斜区脑膜瘤,〈2.5 cm者6例,2.5~3.5 cm者16例,〉3.5 cm者8例。术后出现外展神经功能障碍者〈2.5 cm者0例,2.5~3.5 cm者5例,〉3.5 cm者4例。暂时性外展神经功能障碍者7例,永久性障碍者2例。结论岩斜区脑膜瘤术中外展神经出脑干端、穿岩斜硬脑膜端容易受损伤。提高对Dorello＇s区解剖认识、肿瘤的早期发现、良好的肿瘤暴露、神经粘连处的锐性分离等,有助于切除肿瘤并减少外展神经的医源性损伤。

Objective The clinical data of 30 cases of petroclival meningioma have been summarized in order to improve the resection degree of petroclival meningiomas and reduce the abducent nerve injury.Methods The clinical characteristics,surgical techniques and abducent nerve damages were discussed and the relationship between the microanatomy of Dorello＇s cannal and petroclival meningioma was investigated.Results In 30 cases of petroclival meningiomas,tumor diameter〈 2.5 cm was in 6 cases,2.5 ~3.5 cm in 16 cases,and 〉3.5 cm in 8 cases.After operation for patients with tumor diameter 〈2.5 cm,no abducent nerve dysfunction occurred; for patients with tumor diameter of 2.5 ~3.5 cm,there was 5 cases of abducent nerve dysfunction and for tumor diameter 〉3.5 cm,there were 4 cases.There were 7 cases of temporary dysfunction and 2 cases of permanent injury.Conclusion During the operation of petroclival meningioma,abducent nerve is prone to injury in the places where it originates from the pontomedullary sulcus and pierces the petroclival dura.Better knowledge of Dorello＇s cannal,early diagnosis and good exposure of the tumor,and acute separation in the adhesion will be helpful for the remove of the tumor and reduction of the iatrogenic injury of abducent nerve.