岩骨尖斜坡区巨大脑膜瘤的显微外科治疗

Microsurgical treatment of large petroclival meningiomas

目的 通过对 32例岩骨尖斜坡区巨大脑膜瘤显微外科治疗的疗效分析 ,达到提高显微手术的全切率 ,降低死亡率 ,改善手术效果。方法 回顾性分析 32例岩骨尖斜坡区巨大脑膜瘤病人的临床资料 ,将乙状窦前迷路后幕上幕下联合入路与其它入路的显微外科手术进行比较 ,总结 32例岩骨尖斜坡区巨大脑膜瘤的显微手术方法 ,手术结果和术后处理。结果 肿瘤全切除 18例 (5 6 .3 % ) ,死亡 2例 (6 .3 % )。经乙状窦前迷路后幕上幕下联合入路 2 2例 ,全切除 18例 (81.8% ) ,无死亡。结论 选择好手术入路及运用显微外科技术可以提高岩骨尖斜坡区巨大脑膜瘤的切除率 ,降低死亡率 ,对切除困难者 ,为保证病人术后生存质量 ,可行次全切除 ,术后建议行伽玛刀治疗。

ObjectiveTo discuss microsurgical treatment and results of petroclival meningiomas by analyzing 32 cases to raise the total removal rate, lower operative mortality, and improve operative results. MethodsThe clinical data of 32 patients were reviewed. Thirty-two cases of petroclival meningiomas were all treated by microsurgery; operative approaches were compared between the supra-and-infratentorial combimed with presigmoid-retrolabyrinthine-transpetrosal one and others. The operative approaches, results of operation and postoperative management of petroclival meningiomas were discussed for the 32 patients. ResultsTotal resection was achieved in 18 patients ( 56.3%). Two patients died ( 6.3%). Twenty-two cases of petroclival meningiomas were operated by combined presigmoid retrolabyrinthine and supra-infratentorial approach. Total removal was achieved in 18 patients ( 81.8%), and no one died in the operation. ConclusionTotal resection can be achieved in most cases with microneurosurgical technique. Satisfactory operative approaches may raise the total removal rate and lower the operation mortality and morbidity. Since the most important goal of surgery is a good postoperative result, subtotal removal of tumor and residual tumor by gamma knife therapy should be considered when the tumor is large or without arachnoidal dissecting plane.