最小化经岩骨前后路联合入路切除大型/巨大型岩斜区脑膜瘤的临床观察  

Minimal anterior and posterior combinedtranspetrosal approach for large/gaintpetroclival meningiomas

作　　者：张伟[1] 赵乐 李涛[1] ZHANG Wei;ZHAO Le;LI Tao(The Second Ward of Neurosurgical Department,Yulin Second Hospital,Yulin 719000,China)

机构地区：[1]榆林市第二医院神经外科二病区,陕西榆林719000

出　　处：《临床肿瘤学杂志》2023年第2期168-171,共4页Chinese Clinical Oncology

摘　　要：目的旨在描述最小化前路和后路联合(APC)经岩骨入路切除大型/巨大型岩斜区脑膜瘤(PCMs)的手术技术和临床疗效。方法2017年4月至2021年1月,对16例接受最小化APC经岩骨入路的良性(WHO分级I级)大型/巨大型PCMs(≥30 mm)患者进行回顾性分析。手术技术包括颞枕下开颅术和最小化岩骨磨除术。评估手术和临床结局、并发症及随访结果。结果平均手术时间(8.2±2.1)h。肿瘤体积由术前(26.3±10.9)cm^(3)减小至(1.3±1.9)cm^(3),15例(93.8%)患者肿瘤切除率≥90%,包括8例肉眼全切除和7例次全切除;1例获得肿瘤部分切除。术后损伤包括面部麻木2例,滑车神经麻痹1例,轻度动眼神经麻痹1例,一过性外展神经麻痹1例。无新发运动障碍。术后karnofsky功能状态改善10例(62.5%),稳定6例(37.5%),无恶化病例。结论最小化APC经岩骨入路能充分广泛显露岩斜区肿瘤,可最大程度地安全切除大型/巨大型PCMs。Objective To describe the surgical technique and clinical efficacy of minimal anterior and posterior combined(APC)transpetrosal approach for resection of large/giant petroclival meningiomas(PCMs).Methods From April 2017 to January 2021,16 patients with benign(WHO grade I)large/giant PCMs(≥30 mm)who received the minimal APC transpetrosal approach were retrospectively analyzed.The surgical techniques include infratemporal occipital craniotomy and minimal petrous bone grinding.The surgical and clinical outcomes,complications and follow-up results were evaluated.Results The average operation time was 8.2±2.1 h.The tumor volume decreased from(26.3±10.9)cm^(3) to(1.3±1.9)cm^(3) before operation.The tumor resection rate of 15 patients(93.8%)was≥90%,including 8 cases of gross total resection and 7 cases of subtotal resection;One case was partially resected.Postoperative injuries included facial numbness in 2 cases,trochlear nerve palsy in 1 case,mild oculomotor nerve palsy in 1 case,and transient abducent nerve palsy in 1 case.No new movement disorder.Karnofsky’s functional status improved in 10 cases(62.5%),stabilized in 6 cases(37.5%),and did not deteriorate.Conclusion The minimal APC transpetrosal approach can fully and extensively expose petroclival tumors,and can safely resect large/giant PCMs to the greatest extent.

关 键 词：最小化岩骨磨除 前路和后路联合经岩骨入路 大型/巨大型 岩斜区脑膜瘤 

分 类 号：R739.91[医药卫生—肿瘤]