枕骨大孔区腹侧脑膜瘤的显微手术技术探讨  

Microsurgery through Far Lateral Approach for Meningiomas in Foramen Occipitale Magnum Regions

作　　者：张连群[1] 许崇福[1] 刘鹏[1] 高志宇[1] 刘卫东[1] 

机构地区：[1]聊城市人民医院分部--脑科医院神经外科,山东聊城252000

出　　处：《中国临床神经外科杂志》2007年第7期388-390,共3页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨远外侧入路在治疗枕骨大孔区腹侧脑膜瘤中的应用。方法对14例脑膜瘤患者采用远外侧入路显微手术治疗,其中枕髁后入路8例,经部分枕髁入路3例,经C1、2关节面侧方联合部分枕髁入路2例,经完整枕髁入路1例。结果肿瘤全切11例,次全切除3例;1例行枕颈融合,无手术死亡病例。所有患者术后均未出现寰枕关节不稳定的症状,手术并发症主要是后组颅神经损伤、椎动脉损伤、脑脊液漏以及脑干缺血。结论远外侧入路是手术治疗下斜坡区和上段颈髓腹侧、腹外侧病变的理想入路,可以理想显露肿瘤及其基底部并减少术中出血,但手术操作比较复杂且具有一定的风险。Objective To explore the application of microsurgery through far lateral approach to the meningomas in the foramen occipitale magnum regions. Method Of 14 patients with meningomas in the foramen magum regions, 8 underwent microsurgery through retrocondylar approach, 3 partial transcondylar approach, 2 transfaceted and partial transcondylar approach, and 1 complete transcondylar approach. Results Of 14 patients, 11 received total removal of the tumors and 3 subtotal removal. The occipitoceivical fusion was performed in 1 patients. The clinical instability of the occipito-atlantal junction did not occurred after the surgery in all the patients. No patients died from the operation. The main complications included damage to the lower cranial nerves （2 cases） and to the vertibral artery （1 case）, CSF leakage （2 cases） and ischemia of brain stem （1 case）. Conclusions The far lateral approach is an ideal approach to meningomas in the region ventral and ventrolateral to cranioceivical junction because the tumors and their bottoms may be exposed well and the intraoperative bleeding may decrease in the patients undergoing surgery through the approach. But some of the surgical steps are technically difflcuh and have a little risk when the approach is performed.

关 键 词：脑膜瘤 枕骨大孔区腹侧 远外侧入路 

分 类 号：R739.45[医药卫生—肿瘤]