颞下入路切除骑跨岩尖型脑膜瘤的临床研究

Clinical study of infratemporal approach for the removal of petrous apex meningioma

目的总结骑跨岩尖型脑膜瘤的临床显微手术技巧。方法回顾性分析35例骑跨岩尖型脑膜瘤病例资料,均采用颞下入路,肿瘤直径≥3 cm 21例,<3 cm 14例。结果肿瘤切除达到SimpsonⅠ级32例,Ⅱ级2例,Ⅲ级1例,无死亡病例。术后3个月内三叉神经障碍6例,动眼神经障碍4例,展神经障碍2例。术后随访2～8年,平均5.5年,三叉神经障碍2例,动眼神经障碍1例。结论骑跨岩尖型脑膜瘤手术复杂,对外科医生的颅底解剖知识、显微操作技术要求很高。颞下入路可良好显露肿瘤和保护神经血管,获得较佳手术疗效,是常用手术入路。

Objective To summarize the microsurgical technique of straddling petrous apex meningioma. Methods Clinical data of35 patients with straddling petrous apex meningioma were analyzed retrospectively. The infratemporal approach was performed in all35 cases. The tumor diameter was ≥3 cm in 21 patients and 〈3 cm in 14. Results The resection of Simpson Grade Ⅰ was achieved in 32, Grade Ⅱ in 2 and Grade Ⅲ in 1. There was no death. The trigeminal nerve dysfunction, oculomotor nerve dysfunction and abducens nerve dysfunction occurred in 6, 4 and 2 patients respectively within 3 months after surgery. The patients were followed up for 2 to 8 years with the mean period of 5.5 years, the trigeminal nerve dysfunction was seen in 2 patients and oculomotor nerve dysfunction in 1. Conclusions The operation of straddling petrous apex meningioma is complicated, and the neurosurgeons require full knowledge of skull base anatomy and high microsurgical technique. The infratemporal approach could exhibit perfect surgical field for tumor exposure and protect the nerves and blood vessels, thus should be recommended.