目的通过总结本病的放射学特点、手术入路和治疗效果,以探讨岩斜坡脑膜瘤的手术策略和如何改善手术效果。方法回顾性分析21例岩斜坡脑膜瘤,采用3种手术入路显微外科治疗,包括(1)经岩骨-天幕入路3例;(2)乳突后枕下入路15例;(3)远外侧枕下入路3例。结果术后恢复良好者19例(90.5%),经术后CT或MR证实肿瘤全切除者13例(62%),无手术死亡。术后新增颅神经损害10例(47%),其中永久性损害3例(14%)。肿瘤巨大、肿瘤血管化或纤维化、脑干与肿瘤之间的蛛网膜界面消失、基底动脉供血等因素增加手术困难,影响术后效果。结论采用合适的手术入路和精良的显微外科技术可以提高岩斜坡脑膜瘤的全切除率,降低残死率。但保证病人术后生存质量是最重要的手术目的,当肿瘤巨大或蛛网膜界面消失时,全切除肿瘤会十分困难,应考虑次全切除肿瘤,术后用γ-刀处理残余肿瘤。 Objective To summarize the radiological characteristics of the disease, surgical approach and treatment effect to explore the surgical strategy of rock slope meningioma and how to improve the surgical results. Methods Twenty-one patients with meningioma were retrospectively analyzed. Three surgical approaches including microsurgical treatment were included: (1) 3 cases were treated by the petrous bone-canopy approach; (2) posterior suboccipital approach was performed in 15 cases; 3) far lateral suboccipital approach in 3 cases. Results 19 cases (90.5%) were well recovered after operation. Thirteen patients (62%) had complete tumor resection after CT or MR operation without any operative death. Ten patients (47%) had cranial nerve damage after operation, among which permanent injury was found in 3 patients (14%). A huge tumor, tumor vascularization or fibrosis, disappearance of the arachnoid interface between the brain stem and tumor, basilar artery blood supply and other factors increase the difficulty of surgery, the impact of postoperative effects. Conclusion The appropriate surgical approach and sophisticated microsurgical techniques can increase the total resection rate of meningioma and reduce the death rate. But to ensure the quality of life of patients is the most important surgical purposes, when the tumor is huge or the disappearance of arachnoid interface, the total removal of the tumor will be very difficult, should consider subtotal resection of the tumor, postoperative residual tumor treatment with γ-knife.