颞下经小脑幕岩骨嵴入路切除岩斜区脑膜瘤的显微外科治疗

摘要

Objective:To explore the clinical effect of ablating petroclival region meningiomas by infratemporal and tentorail-crista petrosa approach in the condition of microsurgery. Methods:The clinical data of 23 patients with petroclival region meningiomas were retrospectively analyzed. The infratemporal and tentorail-crista petrosa approach was chosen. And among these patients,suboccipital ret-rosigmoid approach was associated in 7 cases. Results:The ablating level of tumor is based of Simpson grade:ⅠtoⅡgrade ablated in 12 cases,Ⅲgrade ablated in 3 cases andⅣgrade ablated in 8 cases. After the operation,there is coma in 2 cases,facial nerve function less than Ⅲ grade in 7 cases,optical movement disorder in 11 cases,hearing disturbance in 2 csase,muscle weakness in 3 cases,in-tracranial infeion in 2 cases and one patient died. 15 patients had been follow-up visited in 6-30 months. In these patients,most of the preoperative symptoms and postoperative complications had been improved. In the follow-up phase,the tumor does not reoccur and rem-nant tumor has no advanced in 10 cases. The tumor recurred obviously,and then had been operated in 5 cases. Conclusion:It is an im-portant method that petroclival region meningiomas is operated through infratemporal and tentorail-crista petrosa approach. It has the merit of satisfactory exposure and little surgical trauma. The suboccipital retrosigmoid approach could increase more infratentorail expo-sure range. With regard to the tumor which could not be all ablated more than SimpsonⅢgrade,it should be assisted with gamma knife radial therapy to inhibit the progress of remnant tumor,and then decrease its recurrence rate.%目的：探讨显微外科条件下以颞下经小脑幕岩骨嵴入路切除岩斜区脑膜瘤的临床疗效。方法：回顾性分析23例岩斜区脑膜瘤病人的临床资料,手术入路均选择颞下经小脑幕岩骨嵴入路,其中7例联合幕下乙状窦后入路。结果：对术后肿瘤切除程度根据Simpson分级：Ⅰ~Ⅱ级切除12例；Ⅲ级切除3例；Ⅳ级切除8例。术后出现昏迷2例；面神经功能小于Ⅲ级7例；眼球运动障碍11例；听力障碍2例；肢体肌力下降3例；颅内感染2例；死亡1例。15例随访6~30个月,术前症状及术后并发症大部分不同程度改善,随访期内10例无肿瘤复发及残余肿瘤进展,5例肿瘤明显复发再次手术。结论：颞下经小脑幕岩骨嵴入路是岩斜区脑膜瘤手术治疗的重要方式,具有暴露满意、手术创伤小的优点。联合幕下乙状窦后入路可进一步增大幕下的暴露范围。对于无法全切的Simpson Ⅲ级以上肿瘤,术后可辅助γ刀放射治疗抑制残余肿瘤进展,降低复发率。