颞下-乙状窦后联合锁孔入路显微手术治疗岩斜区脑膜瘤的手术策略与技巧  

Surgical strategies and techniques of petroclival meningiomas by trans-subtemporal combined with suboccipital retrosigmoid keyhole approaches

作　　者：陈立华 徐如祥 魏群 李运军 李文德 高进宝 于斌 赵浩 

机构地区：[1]陆军总医院附属八一脑科医院,北京100700

出　　处：《中华神经医学杂志》2017年第4期381-386,共6页Chinese Journal of Neuromedicine

摘　　要：目的探讨采用颞下-乙状窦后联合锁孔入路显微手术切除岩斜区脑膜瘤的手术策略与技巧，以提高肿瘤的全切率和改善预后。方法陆军总医院附属八一脑科医院自2011年1月至2015年12月采用颞下．乙状窦后联合锁孔入路显微切除术治疗岩斜区脑膜肿瘤患者26例，其中单纯采用神经导航引导下手术7例，联合采用神经导航和术中MRI或电生理监测下手术11例，单纯采用神经电生理监测下手术8例。本研究回顾性分析该26例患者的临床资料和疗效，并对手术入路的方法和技巧进行总结。结果本组肿瘤全切除（SimpsonⅠ、Ⅱ级）23例（88．5％），次（近）全切除（SimpsonⅢ、Ⅳ级）3例（11．5％）。术后新增颅神经功能障碍或原有神经功能障碍加重6例（23．1％），无死亡病例。术后半年随访，Kamofsky功能状态评分（KPS）≥170分23例，KPS〈70分3例。术后随访3～35个月，未见肿瘤复发。结论颞下-乙状窦后联合锁孔入路是是切除岩斜区脑膜瘤安全、有效、微创的手术入路，掌握好手术的策略和技巧，有利于提高手术疗效。Objective To summary the microsurgical strategies and techniques of petroclival meningiomas by trans-subtemporal combined with suboccipital retrosigrnoid keyhole approaches to raise the removal rate and improve the prognosis. Methods The clinical data of consecutive 26 patients with petroclival meningiomas, admitted to our hospital from January 2011 to December 2015 and accepted microsurgical treatment, were reviewed retrospectively; 7 of them were guided by neuronavigation, 8 were performed under neuroelectrophysiological monitoring, and 11 were guided by neuronavigation combined intraoperative MRI or neuroelectrophysiological monitoring. The operative methods and techniques, aunor resection rate and Karnofsky performance scale （KPS） scores before and after operation were analyzed. Results Of all patients who underwent surgical treatment by trans-subtemporal combined with suboccipital retrosigmoid keyhole approaches, gross total tumor resection （Simpson I-II） was achieved in 23 patients （88.5%）, subtotal （Simpson HI-W） in 3 patients （11.5%）. Six patients （23.1%） had cranial nerve deficit postoperatively. No mortality which related with operation was noted. Patients were followed up for 3-35 months, 23 patients had KPS scores 〉170, and 3 patients had KPS 〈70; no tumor recurrence or progression was noted. Conclusion The trans-subtemporal combined with suboccipital retrosigmoid keyhole approaches are safe, effective and minimally invasive for resection of petroclival meningiomas; mastering the operation strategies and intraoperative skills is conducive to improve the efficacy of surgery.

关 键 词：岩斜区脑膜瘤 显微外科手术 颞下锁孔入路 乙状窦后锁孔入路 手术技巧 

分 类 号：R739.45[医药卫生—肿瘤]