扩大翼点-经颞叶-经小脑幕入路切除大型及巨大型岩斜区脑膜瘤  

The extended pterional transtemporal transtentorial approach for large and giant petroclival meningiomas

作　　者：文立利[1] 王汉东[1] 马驰原[1] 樊友武[1] 李杰[1] 李劲松[1] 潘云曦[1] 周渊[1] 唐勇[1] 

机构地区：[1]南京军区南京总医院神经外科,210002

出　　处：《中华神经外科杂志》2015年第2期133-136,共4页Chinese Journal of Neurosurgery

摘　　要：目的 总结扩大翼点-经颞叶-经小脑幕入路切除大型及巨大型岩斜脑膜瘤的手术经验及临床预后.方法 回顾性分析33例经扩大翼点-经颞叶-经小脑幕入路切除的岩斜脑膜瘤患者的临床资料,包括大型14例,巨大型19例.结果 肿瘤全切除15例（45％）,次全切除17例（52％）,部分切除1例（3％）.术后死亡1例.28例患者获得随访,平均随访时间为37.8个月.随访截止时11例（39％）患者KPS评分较术前改善,12例（43％）无变化,5例（18％）变差.3例患者肿瘤复发.结论 扩大翼点-经颞叶-经小脑幕入路是切除大型和巨大型岩斜脑膜瘤合适的入路选择,特别适用于向中颅窝及幕上侵及的巨大型岩斜脑膜瘤.Objective To study the surgical techniques and effectiveness of the extended pterional transtemporal transtentorial approach for the resection of large and giant petroclival meningiomas.Methods Some modifications were made to the pterional approach by liberation and retraction of temporal pole,incision of tentorium and petrous apicectomy to provide effective corridor to the sphenopetroclival region.Thirty-three patients with large（14 cases） and giant meningiomas（19 cases） were analyzed retrospectively who received the extended pterional transtemporal transtentorial approach from January 2000 to March 2012.The neurological dysfunction,resection rate and quality of life were analyzed.Results Gross total resection was achieved in 15 patients （45%）,subtotal in 17 （52%） and partial in 1 （3%）.One patient died of hyperthermia and electrolyte disorder postoperatively.Twenty-eight patients were followed-up for mean 37.8 months （range 4-135 months）.Three patients had tumor recurrence.Karnofsky Performance Scale showed the outcome of prognosis was improved in 11 patients （39%）,unchanged in 12 （43%） and deteriorated in 5 （18%）.There was no statistically significance according to Karnofsky Performance Scale compared with that of preoperation.Conclusions The extended pterional transtemporal transtentorial approach was an effective approach for the resection of large and giant petroclival meningiomas,especially for giant meningiomas that predominantly occupied the middle fossa and extended to the supratentorial region.

关 键 词：岩斜脑膜瘤 颅底 显微外科手术 

分 类 号：R739.45[医药卫生—肿瘤]