摘要
目的探讨岩骨-斜坡区脑膜瘤手术入路的选择原则以及并发症的防治,以期进一步提高手术疗效。方法回顾分析自1995年1月～2003年4月收治的49例岩骨-斜坡区脑膜瘤患者的临床资料。临床表现为脑神经受损、头痛、肢体无力和共济失调,其中45例肿瘤最大径>4.5cm。根据MR检查结果,将肿瘤部位分为上中斜坡型(Ⅰ型)、全斜坡型(Ⅱ型)和中下斜坡型(Ⅲ型)。上中斜坡型者23例,12例经颞下-小脑幕入路、8例经颞下-小脑幕-岩尖入路、3例经颞下-乙状窦前入路;全斜坡型者19例,8例经颞下-乙状窦前入路、2例经颞下-迷路入路、9例经枕下-乳突后入路;中下斜坡型者7例,均经枕下-极外侧入路实施手术。结果49例患者中,肿瘤全切除者35例(71.4%);近全切除者10例(大于三分之二);部分切除者4例(小于三分之一)。手术后并发症包括昏迷和偏瘫(2例)、四肢瘫(1例);1例因后组脑神经麻痹引起的肺炎而死亡。脑神经受损或症状加重者18例,其中多数于手术后3个月内恢复功能。结论选择手术入路的基本原则是考虑肿瘤占据斜坡的位置和肿瘤全切除的可能性。
Objective To study the principle of selecting surgical approach, prevention and treatment of complication in petroclival meningioma for further improving the surgical effects. Methods The clinical data of 49 patients with petroclival meningioma hospitalized during January 1995-April 2003 were analyzed retrospectively. The clinical manifestations of these cases were cranial nerve impairment, headache, weakness of extremities and ataxia, 45 cases of them with tumor diameter > 4.5 cm. According to their locations on clivus revealed on MRI, tumors were divided into three categories ie: upper 2/3 of the clivus (typeⅠ), whole clivus (typeⅡ) and lower 2/3 clivus (typeⅢ). Of the 23 cases with typeⅠtumors, 12 were operated via subtemporal cerebellar-tentorial approach, 8 via Kawase approach and 3 via subtemporal presigmoid sinus approach; while in 19 cases of typeⅡtumors, subtemporal presigmoid sinus approach was performed in 8, subtemporal labyrinthine approach in 2 and suboccipital retromastoid approach in 9; all the 7 cases with type Ⅲ tumors were operated via suboccipital extremelateral approach. Results In total of the 49 patients, tumors in 35 cases (71.4%)were totally removed, 10 subtotally (more than 2/3 of mass volume) resected and 4 partially (less than 1/3 mass volume) resected. Postoperative complications included: coma and hemiplegia (n=2), quadriplegia (n=1), and one died from pneumonia resulted in cranial nerve plegia. Cranial nerve impairment or worsened symptoms occurred in 18 cases and most of patients' function recovered postoperatively within 3 months. Conclusion The principle of selecting surgical approach should be based on the location of tumor in clivus and the possibility of total resection of tumor.
