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目的 总结斜坡脑膜瘤的放射学特点、手术入路和治疗效果 ,以提高斜坡脑膜瘤的全切除率 ,降低残死率 ,改善手术效果。方法 回顾性分析一组 34例斜坡脑膜瘤 ,采用 6种手术入路显微外科治疗 ,包括 ( 1)眶颧 颞极入路 9例 ;( 2 )额颞 经海绵窦入路 2例 ;( 3)经岩骨 天幕入路13例 ;( 4)乳突后枕下入路 6例 ;( 5 )远外侧枕下入路 3例 ;( 6 )经口咽 斜坡入路 1例。结果 术后恢复良好者 2 9例 ( 85 % ) ,肿瘤全切除率 5 6 % ,死亡率 2 9%。术后新增颅神经损害 16例 ( 47% ) ,其中永久性损害 4例 ( 12 % )。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 采用颅底手术入路和显微外科技术可以提高斜坡脑膜瘤的全切除率 ,降低残死率。保证病人术后生存质量为最重要的手术目的 ,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, surgical approaches and therapeutic effects of meningioma in slopes to improve the total resection rate of meningioma, reduce the rate of death and improve the surgical results. Methods A retrospective analysis of a group of 34 cases of meningioma of the slopes was performed with 6 kinds of surgical approaches including microsurgery including 9 cases of orbital zygomatic temporal pole approach, 2 cases of frontotemporal approach via cavernous sinus, 3) 13 cases were treated by the sternotope; (4) 6 cases were posterior suboccipital approach; (5) 3 cases were lateral suboccipital approach; (6) 1 case was treated by oropharyngeal slope. Results 29 cases (85%) were well recovered after operation, the total resection rate was 56% and the mortality rate was 29%. There were 16 cases (47%) of newly injured cranial nerves after permanent injury, including 4 cases (12%) permanent damage. 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 surgical difficulties, affecting postoperative effects. Conclusion Skull base surgery and microsurgery can increase the total resection rate of meningioma and reduce the death rate. To ensure the patient’s postoperative quality of life for the most important surgical purposes, when the tumor is huge or the disappearance of arachnoid interface, the total excision of the tumor is very difficult, should consider subtotal resection of the tumor, postoperative γ knife treatment of residual tumor