岩上静脉和岩上窦的解剖变异及其在岩斜脑膜瘤手术中的处理策略和教训

The anatomical variation of superior petrosal vein and superior petrosal sinus and its management and lesson during the surgery for petroclival meningioma

目的探讨岩上静脉(SPV)和岩上窦(SPS)的解剖变异及其在岩斜脑膜瘤手术中的处理策略和教训。方法回顾性分析岩斜脑膜瘤手术治疗病例19例,按照岩斜脑膜瘤的分型采用不同入路方式进行手术,观察SPV和SPS的解剖变异并进行分型,处理手术并发症。结果脑膜瘤手术全切除(SimpsonⅠ/Ⅱ级)63.2%(12例),近全切除(SimpsonⅢ级)36.8%(7例)。术中见SPV和SPS解剖分型Ⅰ型有63.2%(12例),Ⅱ型21.1%(4例),Ⅲ型15.8%(3例)。采用经岩前中颅窝底入路10例,10例离断SPS,2例损伤SPV;采用幕上下经岩骨乙状窦前入路4例,3例离断SPS,1例损伤SPV;采用枕下乙状窦后入路5例,1例损伤SPV。所有病例中,手术离断SPS 68.4%(13例),损伤SPV 21.1%(4例);其中引起严重并发症15.8%(3例)。结论岩斜脑膜瘤手术前通过影像或全脑血管造影(DSA)检查了解SPV和SPS的解剖分型,有助于手术入路的选择,避免术中不必要的损伤,减少术后并发症的发生。

Objective To investigate the anatomical variation of superior petrosal vein(SPV) and superior petrosal sinus(SPS) and its management during the surgery for petroclival meningioma. Methods19 cases of petroclival meningiomas from October 2017 to October 2019 were analyzed retrospectively.Different approach were used to perform the operation according to the classification of petroclival meningioma. The anatomical classification of SPV and SPS was observed and made category. The operative complications were treated. Results Total resection(Simpson I/II) was performed in 12 cases(accounting for 63.2%), and nearly total resection(Simpson III) in 7 cases(accounting for 36.8%). During the operation,there were 12 cases(accounting for 63.2%) of type I in the anatomical variation of SPV and SPS, 7 cases(accounting for 21.1%) of type II and 11 cases(accounting for 15.8%) of type III. There were 10 cases of transpetrosal middle cranial fossa approach, 10 cases of disconnection SPS and 2 cases of injured SPV were.4 cases of supratentorial and infratentorial presigmoid approach were performed, including 3 cases of disconnection SPS and 1 case of injured SPV. 5 cases of retrosigmoid approach were treated, including 1 case of injured SPV. In all cases, 13 cases(accounting for 68.4%) were injured SPS, 4 cases(accounting for 21.1%)were injured SPV, and 3 cases(accounting for 15.8%) were serious complications. Conclusions DSA examination before the operation of petroclival meningioma to understand the anatomical variation of SPV and SPS is helpful for the choice of operative approach, avoiding the unnecessary injury and reducing the postoperative complications.