应用远外侧入路个性化术式治疗枕大孔区腹侧脑膜瘤的手术入路制定及效果评价

Surgical scheme and therapeutic effect of individualized far lateral approach for ventral foramen magnum meningioma

目的探讨远外侧入路个性化术式在治疗枕大孔区腹侧脑膜瘤中的应用及手术效果评价。方法回顾性分析2011年1月—2018年12月河南省人民医院收治的14例枕大孔区腹侧脑膜瘤患者的临床资料,并结合相关文献进行复习。结果14例患者之中,病变全切除(SimpsonⅠ、Ⅱ级)12例,次全切除(SimpsonⅢ级)2例,无手术死亡病例。手术后近期内疼痛症状、呼吸功能障碍、肢体肌力明显恢复。感觉功能障碍恢复过程较慢。随访6~24个月,进行颅颈交界区MRI复查,病变全切除的患者未见复发,2例次全切除的患者,术后进行了伽玛刀辅助治疗,也未见病变明显生长。结论远外侧入路是进行枕大孔区腹侧脑膜瘤切除手术的适合入路。应根据影像学资料、病变特点及患者个体之间的解剖差异决定骨质切除的范围及大小,制定个性化的术式。

Objective To explore the application and surgical effect of indivisualized surgery by far lateral approach in the treatment of ventral meningiomas in the foramen magnum region.Methods The clinical data of 14 patients with ventral meningioma in the foramen magnum region admitted to Henan Provincial People s Hospital from January 2011 to December 2018 were analyzed retrospectively.The relevant literature was reviewed.Results Of 14 patients,12 underwent total resection of the lesion(Simpson gradeⅠandⅡ),and 2 underwent subtotal resection(Simpson gradeⅢ).There were no surgical deaths.Pain symptoms,respiratory dysfunction,and limb muscle strength had significantly recovered in the near future after surgery.The recovery process of sensory dysfunction was slow.Follow up for 6 to 24 months,MRI reexamination of the craniocervical junction area was performed,and no recurrence was observed in patients with complete resection of the lesion.Two patients with subtotal resection underwent gamma knife assisted treatment after surgery,and no significant growth of the lesion was observed.Conclusions The far lateral approach is a suitable approach for the removal of ventral meningiomas in the foramen magnum region.The scope and size of bone resection should be determined based on imaging data,lesion characteristics,and anatomical differences between individual patients,and personalized surgical procedures should be developed.