经颞下岩骨前方入路切除岩斜区脑膜瘤的疗效分析  

Efficacy of resection of petroclival meningiomas via modified subtemporal anterior transpetrosal approach

作　　者：吴雷[1] 郭华[1] 叶敏华[1] 沈晓黎[1] 涂伟[1] 祝新根[1] 

机构地区：[1]南昌大学第二附属医院神经外科,江西330006

出　　处：《中华神经外科杂志》2015年第11期1108-1111,共4页Chinese Journal of Neurosurgery

摘　　要：目的探讨经颞下岩骨前方入路切除岩斜区脑膜瘤的疗效。方法2012年1月至2014年6月南昌大学第二附属医院神经外科采用颞下岩骨前方入路切除内听道以内、桥延沟以上累及中后颅窝的岩斜区脑膜瘤23例，回顾性分析其术后疗效。结果23例患者中，肿瘤全切除16例（SimpsonⅠ～Ⅱ级），次全切除7例（SimpsonⅣ级），无死亡病例。随访3～24个月，1例次全切除的患者肿瘤稍增大。术前症状明显的20例患者，术后13例得到改善。术后出现的短暂性神经功能障碍包括，动眼神经麻痹1例、吞咽困难1例、面瘫4例、颜面部麻木4例、复视2例、对侧肢体活动障碍2例；随访期内症状未见明显改善的有动眼神经麻痹1例、耳聋4例、颜面部麻木2例、眼内斜2例。结论经颞下岩骨前方入路切除内听道以内、桥延沟以上累及中后颅窝的岩斜区脑膜瘤具有一定优势，尽管术后部分患者出现神经功能障碍，但大多数是轻度、可逆、可接受的。Objective To investigate the efficacy of resection of petroclival meningiomas via modified subtemporal anterior transpetrosal approach. Methods Twenty-three patients with petroclival meningioma within the internal auditory canal and above the bridge grike resected by using the modified subtemporal anterior transpetrosal approach at the Department of Neurosurgery, the Second Affiliated Hospital of Nanchang University from January 2012 to June 2014 were analyzed retrospectively. Results None of the 23 patients died in this group. The tumors of 16 patients were totally resected （ Simpson＇ s classification, grade Ⅰ -Ⅱ ） and those of 7 patients were subtotally resected （Simpson＇ s classification, grade Ⅳ）. They were followed up for 3 to 24 months. The tumor of 1 patient with subtotal resection increased slightly. Of the 20 patients with obvious symptoms before procedure, 13 were improved after procedure. They had transient neurological deficit after procedure, including 1 with oculomotor nerve palsy, 1 with dysphagia, 4 with facial paralysis, 4 with facial numbness, 2 with diplopia, and 2 with contralateral limb movement disorder. The symptoms were not improved significantly during follow-up period, including 1 with oculomotor nerve palsy, 4 with deafness, 2 with facial numbness, and 2 with esotropia. Conclusions Resection of petroclival meningiomas within the internal auditory canal and above the bridge grike via subtemporal anterior transpetrosal approach has certain advantages. Although some patients have neurological deficits after procedure, most of them are mild, reversible, and acceptable.

关 键 词：脑膜瘤 显微外科手术 岩斜区 颞下经岩骨前方入路 

分 类 号：R739.45[医药卫生—肿瘤]