摘要
目的 :探索岩尖斜坡区脑膜瘤手术入路和手术效果。方法 :通过显微外科手术治疗 2 1例岩尖斜坡区脑膜瘤 ,根据肿瘤的生长方式和MRI的表现分为三种类型 :Ⅰ型 5例 ,主要向中颅窝生长 (包括海绵窦 ) ;Ⅱ型 4例 ,主要向后颅窝生长 ;Ⅲ型 12例 ,骑跨岩骨分别向中、后颅窝生长。额颞开颅断颧弓颞下入路切除肿瘤 5例 ,颞枕开颅颞下小脑幕入路切除肿瘤 4例 ,乙状窦前入路 10例和乙状窦后入路切除肿瘤 2例。结果 :肿瘤全切除 9例 ,近全切除 11例 ,部分切除 1例 ;无手术死亡。Ⅰ型岩斜坡肿瘤全切除 2例 ,次全切除 3例 ;Ⅱ型岩斜坡肿瘤全切除 3例 ,次全切除 1例 ;Ⅲ型全切除 4例 ,次全切除 7例 ,部分切除 1例。结论 :Ⅰ、Ⅱ型多数能全切除 ,术后效果良好 ;若Ⅰ型岩斜坡脑膜瘤侵犯海绵窦则难以全切除 ,术后容易并发动眼神经损伤。Ⅲ型岩斜坡脑膜瘤全切除非常困难 ,乙状窦前入路是Ⅲ型岩斜坡脑膜瘤最佳的的手术入路。
Objective:To investigate the different surgical approaches and postoperative results of petroclival meningiomas.Methods:A retrospective analysis of microsurgical treatment of 21 cases with petroclival meningiomas was performed. According to the tumor extension and MRI image, these cases were classified as three types: Type Ⅰ, Petroclival meningiomas with major extension into the middle fossa, with or without infiltration of the cavernous sinus (5 cases); Type Ⅱ, Petroclival meningiomas with major extension into the posterior fossa (4 cases); and Type Ⅲ, Petroclival meningiomas with extension into both the middle and posterior fossae (12 cases). Surgical approaches to tumors in this series included frontotemporal trans sylvian approach with zygomectomy (5 cases), subtemporal transtentorial approach (4 cases), combined temporosuboccipital and presigmoid approach (10 cases), and retrosigmoid approach (2 cases).Results:Total tumor removal was achieved in 9 patients (42.9%), subtotal removal in 11, and partial removal in one. There was no surgical mortality. Type Ⅰ petroclival meningiomas were totally removed in 2 and subtotal removal was done in 3 cases. Of type Ⅱ petroclival meningiomas total removal was done in 3 cases and subtotal removal in one .Of type Ⅲ petroclival meningiomas total removal was done in 4 cases, subtotal removal in 7 cases, and partial removal in one.Conclusion:Type Ⅰ,Ⅱpetroclival meningiomas in most cases can be totally removed if the tumor is not involved in the cavernous sinus. It is very difficult to resect type Ⅲ petroclival meningiomas totally, and combined temporo suboccipital presigmoid approach is an optimal choice of surgical approach.
出处
《温州医学院学报》
CAS
2001年第5期273-275,共3页
Journal of Wenzhou Medical College
关键词
脑膜瘤
斜坡
显微外科手术
meningiomas
petroclival
microneurosurgery
