岩斜脑膜瘤15例手术治疗分析  

Surgical treatment of petroclival meningioma: a report of 15 cases

作　　者：王子珍[1] 杨堃[1] 蔡雄[1] 黄秋虎[1] 马春阳[1] 陈政刚[1] 孙邦勇[1] 郑传宜[1] 周建[1] 吴然[1] 

机构地区：[1]海南医学院附属医院神经外科,海南海口570102

出　　处：《海南医学》2012年第15期67-69,共3页Hainan Medical Journal

摘　　要：目的探讨岩斜脑膜瘤的临床特点、手术策略、手术技巧和治疗效果。方法回顾性分析临床资料完整的15例岩斜脑膜瘤病例，总结其临床特点。本组均采用经Kawase入路，手术策略为全切除岩斜区肿瘤，术后辅以γ刀治疗。分析手术后颅神经功能和患者生存状况。结果头痛头晕、外展麻痹和面部麻木是岩斜脑膜瘤的主要症状。手术近全切除肿瘤13例，次全切除2例。12例残余肿瘤术后行γ刀治疗。无手术死亡，术后无新增颅神经损害6例，出现动眼神经麻痹6例，面部麻木7例，外展功能障碍4例，面瘫7例。随访6～59个月（平均38．6个月），12例恢复正常工作和生活，2例生活自理，1例生活需他人照顾。13例无肿瘤复发，2例残余肿瘤增大者中1例经γ刀治疗肿瘤生长得到控制。动眼神经麻痹和面瘫均改善，面部麻木5例部分缓解，外展功能障碍无明显改善。结论对岩斜脑膜瘤应采用合理的手术策略，尽可能减少手术引起的神经损害，有利于提高患者的生存质量。Objective To discuss the clinical characteristics, operative strategies and skills, and outcomes of meningioma in the petroclival region. Methods The clinical data of 15 cases with petroclival meningioma were retro- spectively analyzed. Kawase approach was applied to remove the tumors in all the patients. Then Gamma knife radio- therapy was used as adjuvant therapy for most of these patients. Finally the functions of cranial nerves and the quality of life of the patients were analyzed. Results The most common symptoms were headache, dizziness, paralysis of ab- ducens nerve, and facial numbness. Gross total resections of the tumor were achieved in 13 cases, subtotal resections in 2 cases. Twelve patients with tumor residual after operation were treated by Gamma knife radiotherapy. None of these patients died. After operation, neurological intact were found in 6 cases, oeulomotor palsy in 6 cases, facial numbness in 7 cases, paralysis of abducens nerve in 4 cases. During the follow-up of 6 to 59 months （38.6 months in average）, 12 patients lived a normal life, two could take care of himself, and one should be taken care of by others. Thirteen cases showed no evidence of tumor recurrence. The tumor residual were enlarged in 2 cases, and the tumor volume of one of the two patients became smaller again after Gamma knife radiotherapy. All the patients got complete recovery from paralysis of abducens nerve and facial nerve, 5 cases got partial recovery from facial numbness, minor improvement in abducens nerve deficits. Conclusion Adopting a suitable operative strategy and minimizing the neu- rological damage during operation can improve the postoperative outcome of patients with petroelival meningioma.

关 键 词：岩斜区脑膜瘤 手术策略 神经功能 

分 类 号：R739.45[医药卫生—肿瘤]