摘要
目的 分析显微手术切除岩斜区脑膜瘤的治疗效果、患者预后及影响肿瘤切除相关因素,总结治疗经验,以提高疗效.方法 回顾性分析1991年7月至2010年4月手术治疗的71例岩斜区脑膜瘤患者的临床资料并进行随访.结果 男：女为1.0：2.9,平均年龄（47.0±11.2）岁,病程平均（32.5±3.0）个月.肿瘤大小平均44.4 mm.手术入路主要采用枕下乙状窦后（经小脑幕）入路（65例,91.5％）.肿瘤全切除48例（67.6％）,其中采用枕下乙状窦后（经小脑幕）入路全切除47例（72.3％）,围手术期死亡1例（1.4％）,术后KPS评分平均（73.2±15.6）分.随访64例,随访平均时间（60.7±47.5）个月,末次随访KPS评分平均（83.2±13.4）分.肿瘤复发6例,进展8例,死亡7例.患者术后6个月、1年、3年、5年和10年总体生存率分别为100％、91.3％、89.2％、88.5％和85.7％.肿瘤的质地（P=0.09）、类型（P=0.088）、是否侵犯海绵窦（P =0.001）及是否包裹神经血管（P=0.033）是影响肿瘤切除程度的独立因素.结论 明确影响肿瘤切除程度的因素,个体化地选择手术入路,可提高治愈率,改善患者预后,其中枕下乙状窦后（经小脑幕）入路是一种重要而实用有效的手术入路.
Objective To evaluate the microsurgical treatment strategy of petroclival meningioma,the risk factors of tumor resection and the prognosis of the patients in order to improve the surgical therapeutic effects.Methods The clinical and follow-up data were retrospectively analyzed in a consecutive series of 71 cases with petroclival meningiomas who received microsurgical resection between July 1991 and April 2010.Results The study consisted of 71 patients with a female-to-male ratio 2.9 and mean age （47.0±11.2） years.The mean duration of symptom was （32.5 ± 3.0） months and the mean diameter of tumor was 44.4 ma.The retrosigmoid （transtentorial） approach was mainly chosen （65 cases,91.5%） in the study.Three cases were treated visa transpetrosal presigmoid approach and 3 cases with other kinds of approaches.The gross total removal （GTR） reached in 48 eases （67.6%）.The subtotal removal was achieved in 10 cases and partial removal in 13 cases.Forty-seven cases （72.3%） reached GTR via retrosigmoid （transtetoorial） approach.One case （1.4%） died postoperatively.The mean of postoperative KPS was （73.2±15.6）.Sixty-four cases were followed-up with a mean period of （60.7±47.5） months.The mean KP3 at the last visit was （83.2±13.4）.Recurrence and progression were identified in 6 and 8 cases respectively and 7 cases died during the follow-up period.In the follow-up patients,the overall survival rate was 100% at 6 months,91.3% at 1 year,89.2% at 3 years,88.5%at5 years and 85.7% at 10 years.The tumor texture （P =0.092）,subtype （P =0.088）,depth of invasioninto cavernous sinus （P =0.001） and whether to warp neurovascular structures （P =0.033） had significantcorrelations with the extent of tumor removal.Conclusions With regard of improving therapeutic effect and patient prognosis,adjustable approach should be chosen individually based on the different factors affecting tumor removal.Retrosigmoid （transtentorial） approach was one of the most crucial and effective approaches for the removal of petroclival meningioma.
出处
《中华神经外科杂志》
CSCD
北大核心
2015年第2期137-140,共4页
Chinese Journal of Neurosurgery
关键词
岩骨斜坡脑膜瘤
显微外科手术
手术入路
Petroclival meningioma
Microsurgery
Surgical procedures,operative
