桥小脑角脑膜瘤的显微外科治疗及疗效影响因素分析  

Microsurgical treatment and analysis of therapeutic efficacy factors for cerebellopontine angle meningiomas

作　　者：徐修鹏[1] 刘宁[1] XU Xiupeng;LIU Ning(Department of Neurosurgery,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院神经外科,江苏南京210029

出　　处：《中国肿瘤外科杂志》2024年第2期122-125,共4页Chinese Journal of Surgical Oncology

基　　金：国家自然科学基金青年项目(82203767);江苏省自然科学基金(BK20201077);江苏省科教能力提升工程(ZDXK202225)。

摘　　要：目的探讨桥小脑角(CPA)脑膜瘤的显微外科治疗策略,并分析影响手术疗效的因素。方法回顾性分析南京医科大学第一附属医院神经外科2009年5月至2019年4月收治的137例CPA脑膜瘤患者的临床资料。采用Simpson分级评估肿瘤切除程度,以Karnofsky功能状态评分(KPS)评估预后,应用单因素分析探讨影响肿瘤切除程度的因素。结果137例患者中,132例行枕下乙状窦后入路,5例行颞下+乙状窦后入路。SimpsonⅠ~Ⅱ级切除122例(89.1%),Ⅲ级切除11例(8.0%),Ⅳ级切除4例(2.9%)。术后患者均获得随访,随访时间为(72.4±20.8)个月。随访期间,肿瘤复发2例(1.7%),进展1例(6.7%)。末次随访时KPS评分(92.3±13.1)分,高于出院时的(86.9±9.4)分和术前的(75.8±10.3)分(均P<0.001)。单因素分析结果表明,肿瘤的分型(P=0.013)、大小(P=0.023)、瘤周水肿(P=0.005)、瘤周蛛网膜不完整(P=0.030)为影响肿瘤全切的因素。结论经枕下乙状窦后入路可以切除大多数CPA区脑膜瘤。肿瘤体积较小、瘤周蛛网膜界面清晰、无瘤周水肿、非联合型脑膜瘤术中易获得全切。Objective To explore the strategy of microsurgical treatment for cerebellopontine angle(CPA)meningiomas and to analyze the influencing factors of efficacy.Methods A retrospective review was performed on 137 patients with CPA meningiomas who were consecutively admitted to the Department of Neurosurgery,The First Affiliated Hospital of Nanjing Medical University,from April 2009 to May 2019.The extent of tumor resection was assessed using the Simpson classification.Karnofsky performance status(KPS)scale was used to evaluate the patients'outcomes.Results Among the 137 patients,132 patients underwent tumor resection through suboccipital retrosigmoid approach,and 5 patients underwent tumor resection through subtemporal combined with suboccipital retrosigmoid approach.SimpsonⅠ-Ⅱresection was achieved in 122(89.1%)cases,Ⅲin 11(8%)cases,andⅣin 4(2.9%)cases.All patients were followed up and postoperative follow-up duration was 72.4±20.8 months.Tumor recurrence and progression were identified in 2 cases and 1 case respectively.The KPS at the last visit was 92.3±13.1,which is higher than that at discharge(86.9±9.4)and before operation(75.8±10.3)(both P<0.001).Univariate analysis indicated that the tumor types(P=0.013),the maximum diameter of the tumor(P=0.023),the peritumoral edema(P=0.005),and the incomplete arachnoid interface(P=0.030)are the risk factors influencing total resection.Conclusions Most CPA meningiomas can be removed through suboccipital retrosigmoid approach.Total resection seems to be easier to be achieved when the tumor is non-convexity type,with a small size,intact arachnoid interface,and without peritumoral edema.

关 键 词：桥小脑角 脑膜瘤 枕下乙状窦后入路 危险因素 

分 类 号：R739.45[医药卫生—肿瘤]