岩骨后脑膜瘤(附82例报告)

Posterior petrosal Meningiomas

目的 探讨岩骨后脑膜瘤的分型及手术治疗效果。方法 对 82例经显微手术治疗的岩骨后脑膜瘤进行回顾性分析。根据肿瘤基底附着岩骨后面的不同 ,分为三型 :Ⅰ型肿瘤基底位于内听道外侧的岩骨后面 ;Ⅱ型肿瘤基底位于内听道内侧的岩骨后面 ,可向海绵窦、斜坡生长 ;Ⅲ型肿瘤广基附着于岩骨后面 ,可包绕面听神经或长入内听道内。结果 本组 82例全切除肿瘤 6 8例 ,全切除率 83 %,面神经解剖保留率 98%,面神经功能保留率 81%,听力保留率 6 7%。Ⅰ型 2 8例 10 0 %全切除 ,面神经均解剖保留 ,功能保留率 93%;Ⅱ型 32例全切除率 75 %,面神经解剖保留率 97%,功能保留率 75 %;Ⅲ型 2 2例全切除率 73%,面神经解剖保留率 95 %,功能保留率 73%。结论 Ⅱ、Ⅲ型比Ⅰ型全切除困难且术后神经功能损伤相对明显。在保证神经功能完整的基础上尽可能地全切除肿瘤。

Objective To discuss the classification and the surgical outcome of posterior petrosal meningiomas. Methods A retrospective analysis of 82 patients with posterior petrosal meningiomas was performed. According to the anatomic relation with the posterior petrose and with special reference to the internal auditory canal, posterior petrosal meningiomas were classified into three types:TypeⅠ, locating laterally of internal auditory canal (28 cases); Type Ⅱ, locating medially of internal auditory canal, which may extend to the cavernous sinus and clivus (32 cases); Type Ⅲ, extensively attaching to the posterior petroine, enveloping the Ⅶ?Ⅷ nerves (22 cases). Results 68 of 82 cases were totally resected and the rate of total resection was 83%. The rate of anatomical preservation of facial nerve was 98% while functional preservation rate was 81%. The rate of preservation of hearing was 67%. All tumors of typeⅠwere completely resected and the rate of anatomical preservation of facial nerve was 100% while functional preservation was 93%. As to type Ⅱ, 24 of 32 cases were totally resected and the rate of anatomical preservation of facial nerve was 97% while functional preservation was 75%. For type Ⅲ, 16 of 22 cases were totally resected and the rate of anatomical preservation of facial nerve was 95% while functional preservation was 73%.Conclusions It is more difficult for type Ⅱ and Ⅲ to be resected radically than typeⅠ. The primary principle is to preserve the intact of important vascular and neural structures and then to resect tumor totally as possible as we can.