摘要
目的探讨岩斜坡区脑膜瘤的分型、手术入路及治疗效果。方法回顾性分析中南大学湘雅医院神经外科2011年1月至2020年11月收治的179例岩斜坡区脑膜瘤患者的临床资料。男性28例,女性151例,年龄(49.9±10.2)岁(范围:22~75岁),病程[M(QR)]18.0(40.6)个月(范围:1周至320个月),肿瘤最大径(44.8±10.3)mm(范围:15~80 mm),术前Karnofsky生存质量评分表(KPS)评分为(78.6±13.3)分(范围:40~100分)。根据术前MRI增强扫描图像上肿瘤基底位置、累及范围及生长方式进行分型,并根据分型选择手术入路,分析治疗效果。组间比较采用t检验或χ^(2)检验。结果将179例岩斜坡区脑膜瘤分为5型,其中斜坡型4例、岩斜型60例、岩斜蝶型62例、蝶岩斜型50例(包括2个亚型)及颅底中央型3例。除3例颅底中央型患者未接受手术治疗外,余176例均采用显微外科手术治疗,其中采用乙状窦后入路112例,颞下经天幕经岩骨入路27例,颞前经海绵窦岩骨前入路13例,扩大翼点经天幕入路及乙状窦前幕上下联合入路各12例;肿瘤完全切除124例(70.5%)。斜坡型与岩斜型患者全部采用乙状窦后入路,岩斜蝶型主要采用乙状窦后入路(71.0%,44/62),蝶岩斜Ⅰ型主要采用扩大翼点经天幕入路(40.8%,11/27),蝶岩斜Ⅱ型主要采用颞前经海绵窦岩骨前入路(52.2%,12/23)。176例手术患者中,72例(40.9%)术后出现症状加重或新发神经功能障碍,经积极对症支持治疗后均治愈或好转,无术中及术后死亡病例,所有手术患者均顺利出院。术后164例(93.2%)患者获得随访,随访时长24(48)个月(范围:3~108个月)。末次随访时,12例(10.4%)患者肿瘤复发,14例(28.6%)出现肿瘤进展,89例(54.3%)的神经功能障碍获得改善,38例(23.2%)仍存在不同程度神经功能障碍;KPS评分为(84.2±11.4)分(范围:50~100分),与术前KPS评分相比差异无统计学意义(t=-1.356,P=0.125)。不同类型的岩斜坡区脑膜瘤患者,在脑干水肿(χ^(2)=3
Objective To evaluate the classification of petroclival meningiomas(PCM),proposed selection of microsurgical approach and therapeutic outcomes.Methods Retrospectively analyzed clinical data of 179 cases of PCM from Department of Neurosurgery,Xiangya Hospital,Central South University between January 2011 and November 2020.There were 28 males and 151 females with an age of(49.9±10.2)years(range:22 to 75 years)and the tumor size of(44.8±10.3)mm(range:15 to 80 mm).The mean duration of symptom(M(QR))was 18.0(40.6)months(range:1 week to 320 months)and the mean preoperative Karnofsky performance scale(KPS)was 78.6±13.3(range:40 to 100).The PCM were classified into 5 types according to the difference in the origin of dural attachment,involvement of adjacent structures and growth patterns through preoperative MRI.The surgical approaches were selected based on the proposed classification,and the clinical characteristics,surgical record,and follow-up data of each type were reviewed.Results The PCM were divided into clivus type(CV,4 cases),petroclival type(PC,60 cases),petroclivosphenoidal type(PC-S,62 cases),sphenopetroclival type with 2 subtypes(S-PC,50 cases)and central skull base type(CSB,3 cases).All of 176 cases were obtained microsurgical treatment except CSB type.The gross total resection reached in 124 cases(70.5%)with 112 cases of retrosigmoid approach(RSA),27 cases of subtemporal transtentorial transpetrosal approach,13 cases of pretemporal trancavernous anterior transpetrosal approach(PTCA),12 cases of extended pterional transtentorial approach(EPTA)and presigmoid combined supra-infratentorial approach,respectively.The RSA could be adopted in both of CV type and PC type and most of PC-S type(71.0%).S-PC subtypeⅠand subtypeⅡwere mainly underwent EPTA(40.8%)and PTCA(52.2%),respectively.Seventy-two cases(40.9%)gained new neurological dysfunctions mainly with the cranial nerve paralysis.The postoperative morbidity and complications were recovered or improved with conservative and positive symptomatic and suppo
作者
赵子进
袁贤瑞
袁健
谢源阳
张弛
李昊昱
唐国栋
姜维喜
刘庆
Zhao Zijin;Yuan Xianrui;Yuan Jian;Xie Yuanyang;Zhang Chi;Li Haoyu;Tang Guodong;Jiang Weixi;Liu Qing(不Department of Neurosurgery,Xiangya Hospital,Central South University,Neurosurgical Medical Central,Central South University,Clinical Research Center for Skull Base Surgery and Neurooncology in Hunan Province,Changsha 410008,China)
出处
《中华外科杂志》
CAS
CSCD
北大核心
2021年第9期782-789,共8页
Chinese Journal of Surgery
关键词
脑膜瘤
神经外科手术
岩斜坡区
分型
手术入路
Meningioma
Neurosurgical procedures
Petroclival region
Classification
Microsurgical approach
