北京大学学报（医学版）2016，Vol.48Issue(4)：738-742,5.DOI:10.3969/j.issn.1671-167X.2016.04.034
颞下-乙状窦后联合锁孔入路显微手术治疗岩斜区脑膜瘤
Microsurgical management of petroclival meningiomas combined trans-subtemporal and suboccipital retrosigmoid keyhole approach
陈立华 1杨艺 1魏群 1李运军 1李文德 1高进宝 1于斌 1赵浩 1徐如祥1
作者信息
- 1. 中国人民解放军陆军总医院附属八一脑科医院神经外科，北京 100700
- 折叠
摘要
Abstract
Objective:With the development of modern skull base minimally invasive technology mature and neural radio surgery techniques,it is necessary to re-examine the therapeutic strategy for the treat-ment of petroclival meningiomas.To sum up the operative experience and methods in microsurgical resec-tion of petroclival meningiomas by the combining trans-subtemporal and suboccipital retrosigmoid keyhole approach.To explore the minimally invasive operation approach of petroclival meningiomas,to raise the removal degree and to improve the postoperative result using this approach.Methods:The clinical data of the consecutive 21 patients with the petroclival meningiomas were reviewed retrospectively.The meth-od,degree of tumor resection,techniques of the combining keyhole approach,Karnofsky performance score (KPS)before and after operation were also analyzed.The neuronavigation guided operation was performed in 9 cases,and 12 cases were operated in the neuroelectrophysiological monitoring.Results:Total excision of the tumor resection (Simpson,Ⅰ -Ⅱlevels)was conducted in 18 cases (85.7%,18 /21),and 3 patients underwent close resection (Simpson Ⅲ level,14.3%,3 /21).Postoperative three-dimensional CT showed good lock bone flap restoration;Postoperative pathology confirmed meningioma. Postoperative cranial nerve dysfunction or new original nerve dysfunction were aggravated in 5 cases (23.8%),including transient trochlear nerve (3 cases),abducent nerve (1 case),and the motor branch of trigeminal nerve paralysis (1 case).Abducent nerve paralysis (1 case)appeared,with hearing impairment.After the 3-month follow-up,11 cases had the same KPS aspreoperation,7 cases improved,and 3 cases not improved.The KPS score was 77.14 ±23.12 on average,and there was no statistically significant difference compared with that before operation (P >0.05 ).The postoperative follow-up for half a year showed fluent speaking and writing in 19 cases (KPS 70 or higher),and general recovery in 2 cases (KPS <70).The postoperative follow-up for 3 -29 months showed no tumor recur-rence or progress.Conclusion:The combining trans-subtemporal and suboccipital retrosigmoid keyhole approach is simple,safe,and minimally invasive,and an ideal operation approach of petroclival menin-gioma.To master the operation skills and the intraoperative matters needing attention in the operation,is favorable to improve the resection rate and curative effect.关键词
脑膜瘤/显微外科手术/颞下锁孔入路/乙状窦后锁孔入路Key words
Meningioma/Microsurgery/Subtemporal keyhole approach/Retrosigmoid keyhole ap-proach分类
医药卫生引用本文复制引用
陈立华,杨艺,魏群,李运军,李文德,高进宝,于斌,赵浩,徐如祥..颞下-乙状窦后联合锁孔入路显微手术治疗岩斜区脑膜瘤[J].北京大学学报（医学版）,2016,48(4):738-742,5.
