颞下经小脑幕入路切除后颅窝小脑幕切迹型脑膜瘤手术体会  

Experience in the resection of the posterior cranial fossa cerebellar tentorial incisure type meningioma via subtemporal transtentorial approach

作　　者：杨庆哲 吴斌[1] YANG Qingzhe;WU Bin(No.7 Ward,Department of Neurosurgery,Sanbo Brain Hospital Capital Medical University,Beijing 100093,China)

机构地区：[1]首都医科大学三博脑科医院神经外科七病区

出　　处：《中国现代医生》2019年第21期51-54,共4页China Modern Doctor

摘　　要：目的探讨后颅窝小脑幕切迹型脑膜瘤的手术入路选择,并探讨颞下经小脑幕入路的应用价值。方法回顾性分析我院2015年8月~2018年7月共14例主体向后颅窝扩展的小脑幕切迹型脑膜瘤患者的临床资料,术前均行头颅CT、MRI(平扫+增强)检查,根据影像学表现,分析该型肿瘤的手术入路选择,最终均采用颞下经小脑幕入路进行肿瘤切除。结果术后MRI显示SimpsonⅠ级切除12例,SimpsonⅡ级切除2例,术后14例患者症状均出现消失或不同程度的改善,均未出现严重并发症,1例患者出现头晕、走路不稳,术后7 d逐渐消失,1例患者出现术侧听力轻度下降,术后9 d恢复正常。经过3个月~3年随访,所有病例均无复发。结论对主体向后颅窝扩展的小脑幕切迹型脑膜瘤,采用颞下入路能快速断掉肿瘤基底,控制肿瘤出血,且肿瘤全切率较高,并发症较少,是一种较好的术式选择。Objective To discuss the surgical approach of posterior cranial fossa cerebellar tentorial incisure type meningioma and to explore the application value of the subtemporal transtentorial approach.Methods The clinical data of 14 patients with cerebellar tentorial incisure type meningioma with the main body extended to the posterior cranial fossa from August 2015 to July 2018 in our hospital were retrospectively analyzed.All patients were given head CT and MRI (plain scan+enhancement) before surgery.According to the imaging findings,the surgical approach of this type of tumor was analyzed,and the tumor was finally removed by resection via subtemporal transtentorial approach.Results Postoperative MRI showed that 12 cases of Simpson grade Ⅰ resection and 2 cases of Simpson grade Ⅱ resection.After surgery,there were 14 patients whose symptoms disappeared or improved to different extents,and no serious complications occurred.One patient developed dizziness and unstable walking,and gradually disappeared 7 days after surgery.One patient developed mild hearing loss on the operation side and returned to normal 9 days after surgery.After 3 months to 3 years of follow-up visit,there was no recurrence in all cases.Conclusion For the cerebellar tentorial incisure type meningioma with the main body extended to the posterior cranial fossa,the subtemporal approach can quickly cut the tumor base and control tumor hemorrhage,and the total resection rate of tumor is higher with less complications,which is a better surgical procedure.

关 键 词：颞下经小脑幕入路 小脑幕脑膜瘤 小脑幕切迹 后颅窝 

分 类 号：R739.4[医药卫生—肿瘤]