岩斜脑膜瘤显微切除术入路的选择和疗效分析

Microsurgical resection of petroclival meningiomas： choice of surgical approaches, techniques and efficacies

目的探讨岩斜脑膜瘤显微切除手术入路的选择、手术技巧和疗效。方法广西医科大学第一附属医院神经外科自2003年1月至2016年1月采用显微切除术治疗岩斜脑膜瘤患者59例，其中单次手术患者55例（93．2％），二次手术患者4例（6．8％1。手术入路包括：颞下经天幕入路17次（27．0％），乙状窦前经岩嵴入路17次（27．0％），枕下乙状窦后入路29次（46．0％）。回顾性分析患者的临床资料和疗效，按随访结束时患者的Kamofsky功能状态评分（KPS）判断患者的预后。统计患者预后的影响因素。结果59例肿瘤中获全切除31例（52．5％），次全切除19例（32．2％1，大部分切除9例（15．3％）。患者首次围手术期均存活。随访患者55例，失访4例。随访时间3～131个月，平均42．6月。发生永久神经功能损害16例。11例患者复发进展，6例行伽玛刀治疗，1例放疗，4例再手术。死亡2例，均死于复发再手术后。55例患者中预后良好42例，预后不良13例。肿瘤大小、脑干水肿、术前KPS评分是患者预后的影响因素。结论采用适宜手术入路、手术策略和技巧．岩斜脑膜瘤显微切除术的疗效确切。

Objective To investigate the approaches, techniques and efficacies ofmicrosurgical resection of petroclival meningiomas. Methods A total of 59 patients with petroclival meningiomas, admitted to our hospital from January 2003 to January 2016, were chosen in our study; single microscopic resection was performed in 55 patients （93.2%） and re-operation was performed in 4 patients （6.8%）; 29 times （46.0%） via retrosigmoid approach, 17 times （27.0%） via tranpetrosal approach, and 17 time via subtemporal approach （27.0%） were chosen. The clinical data, radiological findings, surgical records and outcomes of patients were retrospectively analyzed, and the prognostic factors was analyzed. Results Complete resection was achieved in 31 patients （52.5%）, subtotal resection in 19 （21.7%） and partial resection in 9 （15.3%）. There was no death in perioperative period. Follow-up were obtained in 55 patients, and median follow-up was 42.6 months （ranged 3-131 months）. Permanent neurological damage occurred in 16 patients （27%）. Tumor recurred in 11 patients： 6 had gamma knife radiosurgery, one had routine radiotherapy, and 4 required re-operation. Two patients died of tumor recurrence/progression reoperation. In these 55 patients, 42 enjoyed good prognosis and 13 had poor prognosis. The tumor sizes, brainstem edema and preoperative Kamofsky performance scale scores were unfavorable prognostic factors. Conclusion By using appropriate approaches, surgical strategies and techniques, the petroclival meningiomas can be removed with relatively favorable outcome.