大型、巨大型岩斜区脑膜瘤的显微外科治疗
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摘要
目的：探讨岩斜区脑膜瘤患者手术切除的程度,总结显微外科手术切除经验。方法：回顾性分析26例大型、巨大型岩斜区脑膜瘤病人的临床资料,肿瘤最大径≥2.5cm,病灶主体均位于岩斜区,采用显微外科手术切除肿瘤,其中颞下经小脑幕入路7例,枕下乙状窦后入路15例,幕上、下联合入路(颞下入路联合乙状窦后入路)2例,眶颧入路2例。结果：脑膜瘤切除程度：全切(SimpsonⅠ.Ⅱ级)13例,次全切(SimpsonⅢ级)4例,大部切除(SimpsonⅣ级)9例。结论：术者应追求肿瘤最大程度切除与尽可能低的术后并发症的平衡点,避免盲目的追求全切肿瘤,根据肿瘤大小、生长方式、侵犯区域等因素个性化选择不同显微手术入路。
Objective:To investigate the extent of tumor resection.to summarize the experience of microsurgical removal of the large and giant petroclival meningioma. Method:We retrospectively reviewed the medical records of 26 patients treated surgical for a large or giant petroclival meningioma.Tumor maximum diameter>2.5cm.Lesions subject are located in the petroclival area.7 cases were conducted with subtemporal transpetrosal,15 with retrosigmoid approach,2 with Supra-infratentorial approach(subtemporal and retrosigmoid sinus combined approach),2 wih orbitozygomatic approach.Result:Of all patients in this group, gross total resection(Simpson GradeⅠorⅡ)was achieved in 13 patients,subtotal resection(GradeⅢ)was achieved in 4 patients,partial resection(Simpson GradeⅣ) was achieved in 9 patients. Conclusion:To avoid blind pursuing gross total resection of tumors,and to find the balance between the extent of tumor resection and reducing postoperative complications.Different surgical approaches should be chosen according to different kinds of large and giant petroclival meningioma,according to the size, growth pattern and encroachment area,etc.
Objective:To investigate the extent of tumor resection.to summarize the experience of microsurgical removal of the large and giant petroclival meningioma. Method:We retrospectively reviewed the medical records of 26 patients treated surgical for a large or giant petroclival meningioma.Tumor maximum diameter>2.5cm.Lesions subject are located in the petroclival area.7 cases were conducted with subtemporal transpetrosal,15 with retrosigmoid approach,2 with Supra-infratentorial approach(subtemporal and retrosigmoid sinus combined approach),2 wih orbitozygomatic approach.Result:Of all patients in this group, gross total resection(Simpson GradeⅠorⅡ)was achieved in 13 patients,subtotal resection(GradeⅢ)was achieved in 4 patients,partial resection(Simpson GradeⅣ) was achieved in 9 patients. Conclusion:To avoid blind pursuing gross total resection of tumors,and to find the balance between the extent of tumor resection and reducing postoperative complications.Different surgical approaches should be chosen according to different kinds of large and giant petroclival meningioma,according to the size, growth pattern and encroachment area,etc.
引文
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[2]Simpson D.The recurrent of intracranial meningiomas after surgical treatment[J]. Neurol Neurosur Psychiiatry,1957,10(20):22-39.
[3]Sutherland GR, Florell R, Louw D, et al.Epidemiology of primary intracranial neoplasms in Manitoba, Canada[J]. Can J Neurol Sci,1987,14(4):586-92.
[4]Kurland LT, Schoenberg BS, Annegers JF,et al. The incidence of primary intracranial neoplasms in Rochester, Minnesota,1935-1977[J].Annals of the New York Academy of Sciences,1982,381:6-16.
[5]Staneczek W, Janisch W. Epidemiologic data on meningiomas in East Germany 1961-1986:incidence, localization, age and sex distribution[J].Gin Neuropathol, 1992,11(3):135-41.
[6]Walker AE,Robins M,Weinfeld FD. Epidemiology of brain tumors:The national survey of intracranial neoplasms[J].Neurology,1985,35 (2):219-226.
[7]Yoneoka Y,Fujii Y,Tanaka R.Growth of Incidental Meningiomas [J].Acta neurochirurgica,2000,142(5):507-551.
[8]Kuratsu J,Kochi M,Ushio Y.Incidence and clinical features of asymptomatic meningiomas[J].J Neurosurgery,2000,92(5):766-770.
[9]Turgut M, Ozcan OE, Bertan V. Meningiomas in childhood and adolescence:a report of 13 cases and review of the literature[J].Br J Neurosurg.,199711(6):501-507.
[10]Erdincler P,Lena G,Sarioglu AC, et al. Intracranial meningiomas in children:Review of 29 cases[J].Surg Neurol,1998,49(2):136-141.
[11]韩群颖,柏根基,王鹤鸣,等. Meckel腔的断层解剖及其临床意义[J].中国临床解剖学杂志,1999,17(2)：109-111.
[12]张岩松,邵君飞,常义,等.幕上下联合经部分迷路—岩尖入路的显微解剖研究[J].中国微侵袭神经外科杂志,2003,8(6)：266-269.
[13]Natarajan SK,Sekhar LN,Schessel D,et al.Petroclival meningiomas:multimodality treatment and outcomes at long-term follow-up[J]. Neurosurgery,2007,60:965-979; discussion 979-981.
[14]Park CK,Jung HW,Kim JE,et al.The selection of the optimal therapeutic strategy for petroclival meningiomas[J].Surg Neurol,2006,66(2):160-165..
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