经乙状窦后道上结节入路切除岩斜区脑膜瘤

Resection of petroclival meningiomas through the retrosigmoid intradural suprameatal ap-proach

目的探讨经乙状窦后道上结节入路切除岩斜区脑膜瘤的手术技巧、疗效及适应证。方法回顾性分析2016年5月—2019年3月采用该入路切除的15例岩斜区脑膜瘤患者的临床特征、手术方法及术后并发症。结果15例术前均表现头痛、5例面部感觉减退、2例面部疼痛、1例听力下降。SimpsonⅡ级切除11例,Ⅲ级切除3例,Ⅳ级切除1例。平均随访15个月,无死亡,术后远期生活质量评估(KPS)评分80~90分。术后头痛15例均缓解,面部感觉减退3例缓解、2例加重、新增2例,面部疼痛2例缓解,听力下降1例未缓解,新增复视2例、6个月后均缓解。结论掌握好适应证,经乙状窦后道上结节入路是切除岩斜脑膜瘤的较好途径。

Objective To investigate the surgical techniques,therapeutic efficacy,and indications of retrosigmoid intradural suprameatal approach for resection of petroclival meningiomas. Methods A retrospective analysis was performed on the clinical features,surgical techniques,and postoperative complications of 15 cases of petroclival meningioma who were operated on through retrosigmoid intradural suprameatal approach from May 2016 to March 2019 via telephone follow-up. Results Before operation,all patients suffered from headache,5 cases suffered from facial hypesthesia,2 cases suffered from facial pain,and 1 case suffered from hearing loss.Simpson grade Ⅱ resection was achieved in 11 cases,grade Ⅲ resection in 3 cases,and grade Ⅳ resection in 1 case. During the mean followed-up period of 15 months,no one died,and the postoperative KPS scores ranged from 80 to 90. After operation,headache was alleviated in all cases;facial hypesthesia was alleviated in 3 cases,was aggravated in 2 cases,and developed in 2 cases;facial pain was alleviated in 2 cases;hearing loss remained in 1 case;diplopia developed in 2 cases,but it was alleviated 6 months later in both cases. Conclusions By grasping the indications,the retrosigmoid intradural suprameatal approach is an effective method for the resection of petroclival meningiomas.