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目的:探讨如何提高岩斜区脑膜瘤手术治疗的效果。方法:回顾性分析51例岩斜区脑膜瘤患者手术治疗的临床资料,比较不同的手术入路特点、岩斜区脑膜瘤侵袭海绵窦的处理策略及神经功能的保护。结果:经岩骨-迷路后-乙状窦前入路26例,枕下乙状窦后入路11例,颞下入路7例,联合入路4例,分期手术3例。根治性切除(GTR)20例,次全切除(NTR)23例,大部分切除(STR)8例。术后1～2周评估神经功能,19例(37%)出现恶化(指出现新的神经功能障碍或原有神经功能障碍加重),26例(51%)同术前,6例(12%)术后改善。术后死亡2例,颞叶水肿2例,脑脊液漏3例。结论:个体化选择设计岩斜区脑膜瘤的手术入路及手术策略对减少神经功能损伤提高疗效有重要意义。
Objective: To explore how to improve the surgical treatment of petroclival meningioma. Methods: The clinical data of 51 patients with petroclival meningioma were retrospectively analyzed. The characteristics of different surgical approaches, the treatment strategies of cavernous sinus invasion by petroclival meningiomas and the protection of neurological function were compared. Results: There were 26 cases of anterolateral sigmoid sinus approach, 11 cases of posterior suboccipital sigmoid sinus approach, 7 cases of infratemporal approach, 4 cases of combined approach and 3 cases of staging. There were 20 cases of radical resection (GTR), 23 cases of subtotal resection (NTR) and 8 cases of most resection (STR). Neurological function was assessed 1 to 2 weeks postoperatively, with worsening in 19 (37%) (or new neurological dysfunction or exacerbation of original neurological dysfunction), 26 (51%) with preoperative and 6 (12% ) Improved after surgery. Postoperative death in 2 cases, temporal lobe edema in 2 cases, 3 cases of cerebrospinal fluid leakage. Conclusion: The individual choice of surgical approach and surgical strategy for the design of petroclival meningioma is of great importance in reducing the neurological impairment and improving the curative effect.