以三叉神经痛起病的小型岩斜区脑膜瘤的手术分析(附18例报道)  

Outcomes of microsurgical removal of small petroclival meningiomas with the onset of trigeminal neuralgia(report of 17 cases)

作　　者：董博凯 王壮壮 刘彦廷[1] 孙拯 田春雷[1] DONG Bo-kai;WANG Zhuang-zhuang;LIU Yan-ting;SUN Zheng;TIAN Chun-lei(Institute of Neurology,First College of Clinical Medical Science,China Three Gorges University&Department of Neurosurgery,Yichang Center People's Hospital,Yichang 443003,China)

机构地区：[1]三峡大学宜昌市中心人民医院神经外科,湖北宜昌443003

出　　处：《中国临床神经外科杂志》2023年第5期314-317,共4页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨以三叉神经痛起病的小型岩斜区脑膜瘤(PCM)的手术方法及其疗效。方法回顾性分析2015年5月至2021年5月手术治疗的18例以三叉神经痛起病的小型PCM的临床资料。结果4例采用乙状窦后入路,14例采用改良颞下岩前入路。肿瘤切除达到Simpson分级Ⅰ级15例,Ⅱ级2例,Ⅲ级1例。术后发生面瘫2例。术后随访6~16个月,全切除肿瘤无复发,残余肿瘤无进展;末次随访KPS评分与BNI评分较术前明显改善(P<0.05),而且改良颞下岩前入路KPS评分、BNI分级明显优于乙状窦后入路(P<0.05)。结论对以三叉神经痛起病的小型PCM,显微手术是首选治疗方法,改良颞下岩前入路可能更好。Objective To investigate the choice of operative approach and surgical outcomes of patients with small petroclival meningiomas(PCM)with the onset of trigeminal neuralgia(TN).Methods The clinical data of 18 patients with small PCM with the onset of TN who underwent microsurgery from May 2015 to May 2021 were analyzed retrospectively.Results Of 18 patients,4 patients received surgery through retrosigmoid approachand and 14 through modified anterior transpetrous approach.Simpson gradeⅠwas achieved in 15 patients,gradeⅡin 2,and gradeⅢin 1.Facial paralysis occurred in 2 patients after the surgery.The postoperative follow-up ranged from 6 months to 16 months.There were no recurrence of totally resected tumors or progression of residual tumors.At the last follow up,the KPS and BNI scores were significantly improved(P<0.05),and they were significantly better in patients receiving modified anterior transpetrous approach than those in patients receiving posterior sigmoid sinus approach(P<0.05).Conclusions For patients with small PCM with the onset of TN,microsurgery is the preferred treatment,and the outcomes of surgery through modified anterior transpetrous approach may be better.

关 键 词：岩斜区脑膜瘤 三叉神经痛 颞下岩前入路 乙状窦后入路 显微手术 疗效 

分 类 号：R739.41[医药卫生—肿瘤] R651.11[医药卫生—临床医学]