17例岩斜区脑膜瘤显微神经外科手术治疗效果分析  

Analysis of the surgical treatment in 17 cases of petroclival meningioma

作　　者：杨帆 韦硕 纪培志 孙鳞 赵英玉 蒋昊 范月超 YANG Fan;WEI Shuo;JI Peizhi;SUN Lin;ZHAO Yingyu;JIANG Hao;FAN Yuechao(Department of Neurosurgery,the Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221002,China)

机构地区：[1]徐州医科大学附属医院神经外科,江苏徐州221002

出　　处：《徐州医科大学学报》2018年第6期380-384,共5页Journal of Xuzhou Medical University

基　　金：江苏省六大人才高峰D类资助项目（2014-WSW-033）

摘　　要：目的探讨颞下经岩前小脑幕入路及枕下乙状窦后入路切除岩斜区脑膜瘤的方法和疗效。方法回顾性分析自2015年1月至2017年2月经上述2种手术方式治疗的17例岩斜区脑膜瘤患者的临床资料。当瘤体主要位于岩骨前部上斜坡时选择颞下入路，当瘤体主要位于后颅窝时选择枕下乙状窦后入路。结果9例患者行颞下经岩前小脑幕入路切除，7例行枕下乙状窦后入路切除，1例行颞下入路及枕下乙状窦后联合入路。肿瘤全切除5例，次全切除8例，大部分切除4例。术后患者神经功能障碍较术前痊愈4例，好转7例，无好转及加重6例。术后新增神经功能障6例。术后随访5～26个月，全切除病例中无复发，次全切除及大部分切除病例中未见残余肿瘤明显增大。结论颞下经岩前小脑幕入路和枕下乙状窦后入路操作简单、创伤小、术后并发症少、症状缓解率高，是岩斜区脑膜瘤良好的手术方式。手术应以保留患者的神经功能及提高生活质量为主要治疗目标，不应过分追求肿瘤的全切除。Objective To discuss the efficacy of the treatment of petroclival meningioma through subtemporal transtentorial or lateral suboccipital retrosigmoid approach. Methods A retrospective analysis was conducted using data from 17 petroelival meningioma patients who underwent surgery from January 2015 to February 2017. The subtemporal transtentorial approach was performed when the meningioma was mainly located in the front of the petrous bone and upper eli- vus. In contrast, the lateral suboceipital retrosigmoid approach was adopted when the tumor was mainly located in the posterior fossa. Results In the study, 9 patients underwent surgery through the subtemporal transtentorial approach, 7 patients through the lateral suboccipital retrosigmoid approach and 1 patient through a combined approach of subtemporal transtentorial and lateral suboccipital retrosigmoid. Furthermore, 5 patients received total resection, 8 patients received subtotal resection and 4 received partial resection. After operation, 4 patients reported disappearance of symptoms and signs, 7 patients presented relieved symptoms and 6 patients showed no changes in the symptoms. Neurological disorder appeared in 6 patients. Postoperative follow - up times were 5 to 26 months. No relapse was found in total resection cases. No residual tumor was increased in subtotal and partial resection cases. Conclusions Subtemporal transtentorial and lateral suboccipital retrosigmoid approaches are effective surgical methods to treat petroclival meningiomas, with simple procedures, and little trauma and postoperative complications. During treatment of petroclival meningiomas, patients＇ nerve function should be reserved to improve the quality of life. The total resection of tumor is not suggested under certain conditions.

关 键 词：岩斜区脑膜瘤 颞下经岩前小脑幕入路 枕下乙状窦后入路 

分 类 号：R651.1[医药卫生—外科学]