岩斜区脑膜瘤手术治疗及预后分析  

Surgical treatment and prognostic analysis of petroclival meningiomas

作　　者：张俊延[1] 李达[1] 郝淑煜[1] 王亮[1] 林久銮[1] 杨阳[1] 汤劼[1] 肖新如[1] 吴震[1] 张力伟[1] 

机构地区：[1]首都医科大学附属北京天坛医院神经外科,100050

出　　处：《中华神经外科杂志》2012年第4期327-332,共6页Chinese Journal of Neurosurgery

基　　金：卫生部卫生公益性行业科研专项项目（200902004）;首都医学发展基金（2009-1040）;国家自然科学基金（81141028）

摘　　要：目的分析岩斜区脑膜瘤手术治疗及长期预后。方法回顾性分析426例岩斜区脑膜瘤临床资料并进行随访，采用KPS评分对术前后状况进行评估，并对预后及远期生存相关因素进行分析。结果有效随访314例，男85例，女229例，术前KPS评分72．9±10．5。主要手术入路为经岩骨乙状窦前入路（53．5％），肿瘤大小为（4．1±1．0）cm，全切53．8％（SimpsonⅠ或Ⅱ级），手术死亡率2．1％，术后KPS评分为65．5±16．1。平均随访71．2个月，复发28例，死亡23例。随访KPS评分为74．2±28．2。术前KPS评分、肿瘤与脑干粘连和与血管神经关系等均为预后KPS（≥80分）和远期生存的独立因素。5年、10年和15年的总生存率分别为93．0％、90．6％和70．0％。结论手术为首选治疗策略。以保留患者神经功能和改善预后生活质量为前提，行个体化治疗，未全切者应规律复查，以决定是否辅助放疗。复发病例则应积极治疗。Objective To analyze the long - term surgical outcomes and prognostic factors of petroclival meningiomas. Methods Clinical data of 426 cases of petroclival meningiomas were retrospectively analyzed and followed - up to evaluate the prognostic factors of outcomes and long - term survival. The pre - and post - operative status of patient was evaluated by Karnofsky Performance Scale （KPS）. Results After a mean follow - up duration of 71.2 months, 314 patients （ 85 males and 229 females） were included in the recent study with a mean preoperative KPS of 72.9 ± 10. 5. The most frequent approach was presigmoid transpetrosal approach （53.5%）, complete resection （Simpson Grade I or II ） was achieved in 53. 8% patients, and the surgical mortality was 2. 1%. Postoperative KPS at discharge and at recent evaluation was 65.5 ± 16. 1 and 74. 2 ± 28.2 respectively. Recurrence was found in 28 patients and 23 patients died during follow - up. Preoperative KPS, relationships between tumor and brain stem, vessels and nerves were independent prognostic factors of recent KPS and long - term survival. The overall survival rates were 93.0% at 5 years, 90. 6% at 10, and 70. 0% at 15 years. Conclusions Surgical treatment was the first and the best option for petroclival meningiomas. With regard of neurological function and life quality, gross total resection and individual treatment should be achieved as far as possible. Patients with incomplete resection should be followed -up with MRI scan regularly to decide whether to undergo radiotherapy. Aggressive treatment should be administered for patients with recurrence.

关 键 词：脑膜瘤 岩斜区 乙状窦前 预后 经岩骨入路 

分 类 号：R739.45[医药卫生—肿瘤]