岩斜区脑膜瘤手术入路的选择及预后相关因素分析  

Surgical approach for petroclival meningiomas and analysis on related factors affecting prognosis

作　　者：王紫兰 陈周青 顾枫 杨兴宇 葛祎 马超[1] 尤万春[1] 蔡湛[3] 朱昀[1] 王中[1] WANG Zi-lan;CHEN Zhou-qing;GU Feng(Department of Neurosurgery,The First Affiliated Hospital of Soochoo University,Suzhou 215006,China)

机构地区：[1]苏州大学附属第一医院神经外科,苏州215006 [2]苏州大学附属第一医院神经内科,苏州215006 [3]苏州大学附属瑞华医院神经外科

出　　处：《临床神经外科杂志》2021年第5期506-511,共6页Journal of Clinical Neurosurgery

基　　金：江苏省自然青年基金(BK20200203);苏州市第五批姑苏卫生人才培养项目(GSWS2019002)。

摘　　要：目的探讨岩斜区脑膜瘤不同手术入路的选择,以及影响患者预后的相关因素。方法回顾性分析51例岩斜区脑膜瘤患者的临床资料;分析采用不同手术入路患者的肿瘤切除程度、术后并发症及术后肿瘤复发/进展情况。用Karnofsky功能状态(KPS)评分评价患者的预后,分析影响患者预后的相关因素。结果本组患者中采用翼点入路者5例、颞下经天幕入路10例、Kawase入路10例、乙状窦后入路22例、联合入路4例。术后随访中位时间30个月。肿瘤与脑干粘连、术前MRI T_(2)WI显示瘤周水肿及入院KPS评分≤80分对患者的预后影响有统计学意义(P<0.05~0.005);不同手术入路及肿瘤切除程度对患者的预后影响无统计学意义(均P>0.05)。结论岩斜区脑膜瘤手术选择合适的手术入路有利于最大程度切除肿瘤并减少术后并发症。肿瘤与脑干粘连及瘤周水肿提示患者的预后不良。Objective To explore the choice of different surgical approaches for petroclival meningiomas and the related factors affecting the prognosis.Methods The clinical data of 51 patients with petroclival meningioma were analyzed retrospectively.The extent of tumor resection,postoperative complications and postoperative tumor recurrence/progression were analyzed.Karnofsky performance status(KPS)score was used to evaluate the prognosis of patients,and the related factors affecting the prognosis were analyzed.Results The pterional approach was used in5,subtemporal transtentorial approach in 10,Kawase approach in 10,retrosigmoid approach in 22 and combined approach in 4.The median follow-up time was 30 months.Adhesion between tumor and brain stem,peritumoral edema on preoperative MRI T_(2) WI and admission KPS score≤80 had significant effects on the prognosis of patients(P<0.05-0.005).Different surgical approaches and the degree of tumor resection had no significant effect on the prognosis of patients(all P>0.05).Conclusions The selection of appropriate surgical approach for petroclival meningioma is conducive to the maximum resection of the tumor and reduce postoperative complications.Adhesion between tumor and brain stem and peritumoral edema suggest that the prognosis of patients is poor.

关 键 词：岩斜区脑膜瘤 手术入路 并发症 

分 类 号：R739.41[医药卫生—肿瘤]