岩斜区脑膜瘤的显微外科手术治疗及预后影响因素分析

Efficacy of Microsurgery in the Treatment of 86 Cases with Petroclival Meningiomas and Prognostic Factors

目的探讨显微外科手术对岩斜区脑膜瘤的疗效及预后影响因素。方法选取86例岩斜区脑膜瘤患者,均给予显微外科手术治疗。观察并记录患者治疗后手术切除程度、术前术后NIHSS评分,随访期间并发症情况以及影响预后的危险因素,评估显微外科手术对岩斜区脑膜瘤的疗效。结果术后MRI复查证实全切除患者52例,占60.5%;部分切除患者34例,占39.5%。死亡3例,死亡率3.5%。术前患者NIHSS评分(23.8±4.6)分,术后患者NIHSS评分为(16.7±3.8)分,术后患者NIHSS评分明显降低(P<0.05)。随访期间,86例患者中有2例患者出现新的神经功能障碍;1例肢体功能障碍;2例癫痫;2例脑积水。经单因素分析发现年龄、术前生存质量、肿瘤类型、质地、肿瘤是否包裹神经血管、脑干水肿均是影响预后的危险因素。结论显微外科手术是治疗岩斜区脑膜瘤的首要方法,手术操作过程中注重操作技巧,可降低手术风险,减少术后并发症。影响手术预后的因素较多,故手术治疗应根据患者基本情况制定个体化治疗方案。

Objective To discuss the efficacy of microsurgery in the treatment of 86 cases with petroclival meningiomas and prognostic factors. Methods 86 patients with petroclival meningiomas were selected,they were given microsurgery. The efficacy of microsurgery in the treatment of 86 cases with petroclival meningioma was evaluated by the degree of surgical resection, preoperative and postoperative NIHSS score, complications during follow-up and risk factors affecting the prognosis. Results There were 52 cases with total resection （60.5 % ）. There were 34 cases with partial resection （39.5 % ）. 3 cases died and mortality rate was 3.5%. 1 patients died of coronary heart disease. The preoperative NIHSS score was （23.8 ±4.6） points. The postoperative NIHSS score was （16.7 ± 3.8 ）points. During follow-up ,2 cases showed new neurological deficits. 1 cases showed limb dysfunction. 2 cases showed epilepsy and 2 cases showed hydrocephalus. Analyzing the risk factors affecting prognosis, it could be known that the age, quality of life, tumor type, texture, encapsulated nerve blood vessel and brain stem edema were the risk factors. Conclusion The microsurgery is the primary method to treat petroclival meningiomas. The operative technique should be paid attention in order to reduce the risk of operation and postoperative complications. There are many factors affecting prognosis of surgery. Therefore, the individualized treatment should be based on the basic situation of patients.