颞下-乙状窦后联合锁孔入路显微手术治疗岩斜区脑膜瘤  

Microsurgical management of petroclival meningiomas combined transsubtemporal and suboccipital retrosigmoid keyhole approach

作　　者：陈立华[1] 杨艺[1] 魏群[1] 李运军[1] 李文德[1] 高进宝[1] 于斌[1] 赵浩[1] 徐如祥[1] 

机构地区：[1]中国人民解放军陆军总医院附属八一脑科医院神经外科,北京100700

出　　处：《北京大学学报（医学版）》2016年第4期738-742,共5页Journal of Peking University:Health Sciences

摘　　要：目的：探讨应用颞下-乙状窦后联合锁孔入路显微手术切除岩斜区脑膜瘤的方法和经验,以及岩斜区脑膜瘤的微侵袭手术入路和方法,提高肿瘤的全部切除率与术后疗效。方法：回顾性分析经颞下-乙状窦后联合锁孔入路治疗的21例岩斜区脑膜瘤的临床资料,总结联合锁孔手术的方法和技巧,并对肿瘤切除程度和手术前后功能状态评分（Karnofsky performance score,KPS）进行分析,其中在神经导航引导下手术9例,在神经电生理监测下进行的手术12例。结果：肿瘤全部切除（SimpsonⅠ、Ⅱ级）18例（85.7%,18/21）,次（近）切除（SimpsonⅢ级）3例（14.3%,3/21）,术后三维CT显露锁孔骨瓣复位良好,术后病理均证实为脑膜瘤。术后新增颅神经功能障碍或原有神经功能障碍加重5例（23.8%）,其中短暂性滑车神经3例、外展神经1例、三叉神经运动支麻痹1例。出现外展神经麻痹的1例,同时伴有听力障碍加重。术后3个月随访时,11例KPS同术前,7例术后改善,3例加重。KPS平均评分77.14±23.12,与术前比较差异无统计学意义（P〉0.05）。术后随访半年,恢复良好者19例（KPS≥70）,恢复一般2例（KPS〈70）。术后随访3~29个月,无肿瘤复发或进展。结论：颞下-乙状窦后联合锁孔入路是简便、安全、微创、理想的切除岩斜区脑膜瘤的手术入路,掌握手术技巧和术中注意事项,有利于提高肿瘤的全部切除率和术后疗效。Objective：With the development of modern skull base minimally invasive technology mature and neural radio surgery techniques, it is necessary to re-examine the therapeutic strategy for the treatment of petroclival meningiomas. To sum up the operative experience and methods in microsurgical resection of petroclival meningiomas by the combining trans-subtemporal and suboecipital retrosigmoid keyhole approach. To explore the minimally invasive operation approach of petroclival meningiomas, to raise the removal degree and to improve the postoperative result using this approach. Methods： The clinical data of the consecutive 21 patients with the petroelival meningiomas were reviewed retrospectively. The meth- od, degree of tumor resection, techniques of the combining keyhole approach, Karnofsky performance score （KPS） before and after operation were also analyzed. The neuronavigation guided operation was performed in 9 cases, and 12 cases were operated in the neuroelectrophysiological monitoring. Results： Total excision of the tumor resection （Simpson, I - II levels） was conducted in 18 cases （85.7%, 18/ 21 ）, and 3 patients underwent close resection （Simpson HI level, 14.3%, 3/21 ）. Postoperative threedimensional CT showed good lock bone flap restoration; Postoperative pathology confirmed meningioma. Postoperative cranial nerve dysfunction or new original nerve dysfunction were aggravated in 5 cases （23.8%） , including transient trochlear nerve （3 cases）, abducent nerve （1 case）, and the motor branch of trigeminal nerve paralysis （1 case）. Abdueent nerve paralysis （1 case） appeared, with hearing impairment. After the 3-month follow-up, 11 cases had the same KPS aspreoperation, 7 cases improved, and 3 cases not improved. The KPS score was 77.14 ± 23.12 on average, and there was no statistically significant difference compared with that before operation （P 〉 0.05 ）. The postoperative follow-up for half a year showed fluent speaking and writing in 19 cases （ KPS 70 or hi

关 键 词：脑膜瘤 显微外科手术 颞下锁孔入路 乙状窦后锁孔入路 

分 类 号：R739.45[医药卫生—肿瘤]