巨大斜坡脑膜瘤的显微外科治疗  

Microsurgical removal of large meningiomas involving the clivus

作　　者：沈建康[1] 史继新[2] 刘承基[2] 胡秉诚[1] 李国文[1] 赵卫国[1] 

机构地区：[1]上海第二医科大学瑞金医院神经外科,200025 [2]南京军区总医院神经外科

出　　处：《中华神经外科杂志》2000年第3期152-155,共4页Chinese Journal of Neurosurgery

摘　　要：目的　总结斜坡脑膜瘤的放射学特点、手术入路和治疗效果 ,以提高斜坡脑膜瘤的全切除率 ,降低残死率 ,改善手术效果。方法　回顾性分析一组 34例斜坡脑膜瘤 ,采用 6种手术入路显微外科治疗 ,包括 ( 1)眶颧 颞极入路 9例 ;( 2 )额颞 经海绵窦入路 2例 ;( 3)经岩骨 天幕入路13例 ;( 4)乳突后枕下入路 6例 ;( 5 )远外侧枕下入路 3例 ;( 6 )经口咽 斜坡入路 1例。结果　术后恢复良好者 2 9例 ( 85 % ) ,肿瘤全切除率 5 6 % ,死亡率 2 9%。术后新增颅神经损害 16例 ( 47% ) ,其中永久性损害 4例 ( 12 % )。肿瘤巨大、肿瘤血管化或纤维化、脑干与肿瘤之间的蛛网膜界面消失、基底动脉供血等因素增加手术困难 ,影响术后效果。结论　采用颅底手术入路和显微外科技术可以提高斜坡脑膜瘤的全切除率 ,降低残死率。保证病人术后生存质量为最重要的手术目的 ,当肿瘤巨大或蛛网膜界面消失时 ,全切除肿瘤十分困难 ,应考虑次全切除肿瘤 。Objective To review the radiological features, operative approaches, microsurgical technique and results in cases of involving clival meningiomas, for rise the total removal rate, lower operative mortality and morbidity and improve operative results.Methods A series of 34 patients harbouring clival meningiomas which were operated on between 1988 and 1997 were analyzed retrospectively. The following approaches were used: (1) orbitozygomatic temporopolar approach in 9 cases; (2) frontotemporaltranscavernous approach in 2 cases; (3) transpetrosal and tentorial approach in 13 cases; (4) suboccipital retromastoid approach in 6 cases; (5) extreme lateral transcondylar approach in 3 cases; (6) transoral transpharyngeal approoach in 1 case. Results Good postoperative results were got in 29 patients(85%). Total excision documented by postoperative CT scans was in 19 patients(56%). Operative death was in 1 patient(2%). Postoperatively, new cranial nerve deficits occurred in 16 patients(47%), of which there was permanent worsening of function of cranial nerve in 4 cases(12%). Intraoperative technical difficulties, which may affect outcome, included tumor consistency, vascularity, lossing the arachnoidal plane of dissection from the brain stem, and vascular and cranial nerve encasement. Conclusion The development and refinements of new cranial base approaches and microsurgical technique have risen total removal rate, with low attendant mortality and acceptable morbidity. Because the most important goal of surgical resection is a good postoperative result, subtotal removal of tumor and residual tumor with gamma knife therapy should be considered when the tumor is large or without arachnoidal dissecting plane.

关 键 词：斜坡脑膜瘤 手术入路 显微外科手术 

分 类 号：R739.45[医药卫生—肿瘤]