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中华脑科疾病与康复杂志(电子版)

中华脑科疾病与康复杂志(电子版) ›› 2022, Vol. 12 ›› Issue (01) : 38 -42. doi: 10.3877/cma.j.issn.2095-123X.2022.01.006

临床研究

不同岩斜区脑膜瘤手术入路的疗效分析
谢宝树1, 何科君1, 李西西1, 杨李轩1, 黄正松1, 张弩1,†()   
  1. 1. 510080　广州，中山大学附属第一医院神经外科
  • 收稿日期:2021-12-20 出版日期:2022-02-15
  • 通信作者: 张弩
  • 基金资助:
    广东省基础与应用基础研究基金(2019A1515110460)

Effect analysis of different surgical approaches for petroclival meningiomas

Baoshu Xie1, Kejun He1, Xixi Li1, Lixuan Yang1, Zhengsong Huang1, Nu Zhang1,†()   

  1. 1. Department of Neurosurgery, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
  • Received:2021-12-20 Published:2022-02-15
  • Corresponding author: Nu Zhang
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谢宝树, 何科君, 李西西, 杨李轩, 黄正松, 张弩. 不同岩斜区脑膜瘤手术入路的疗效分析[J]. 中华脑科疾病与康复杂志(电子版), 2022, 12(01): 38-42.

Baoshu Xie, Kejun He, Xixi Li, Lixuan Yang, Zhengsong Huang, Nu Zhang. Effect analysis of different surgical approaches for petroclival meningiomas[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2022, 12(01): 38-42.

目的

探讨岩斜区脑膜瘤采用不同手术入路的治疗效果。

方法

回顾性分析中山大学附属第一医院神经外科自2013年6月至2020年6月收治的76例岩斜区脑膜瘤患者的临床资料，分析其临床表现、手术效果，同时对不同手术入路的手术效果和并发症进行比较。

结果

76例岩斜区脑膜瘤，肿瘤全切除42例（55.3%），次全切除28例（36.8%），部分切除6例（7.9%）。术后病理提示世界卫生组织（WHO）Ⅰ级脑膜瘤71例（93.4%），WHOⅡ级脑膜瘤5例（6.6%）。术后颅神经受损26例，脑干受损2例，脑脊液漏4例，颅内感染5例。术前平均卡氏功能状态（KPS）评分为（73.6±8.7）分，术后6个月平均KPS评分为（79.7±8.8）分，术后6个月平均KPS评分高于术前（P<0.05）。对不同入路而言，颞下组全切率高于乙状窦后组（P<0.05），但术中出血量多于乙状窦后组（P<0.05）。

结论

岩斜区脑膜瘤大多为良性肿瘤，且多数岩斜脑膜瘤可以获得全切除或次全切除。颞下入路全切率高，但术中出血多于乙状窦后入路。

关键词: 岩斜区, 脑膜瘤, 显微手术, 临床疗效
Objective

To investigate the efficacy of microsurgery on petroclival meningiomas.

Methods

The clinical data of 76 patients with petroclival meningioma admitted to the Department of Neurosurgery, the First Affiliated Hospital of Sun Yat-Sen University from June 2013 to June 2020 were retrospectively analyzed. The effects and complications of different surgical approaches were compared.

Results

Among 76 cases of petroclival meningiomas, 42 cases (55.3%) were totally resected, 28 cases (36.8%) were subtotally resected, and 6 cases (7.9%) were partially resected. Postoperative pathology showed 71 (93.4%) WHO grade Ⅰ meningiomas and 5 (6.6%) WHO grade Ⅱ meningiomas. The sugical complication included 26 cases of cranial nerve injury, 2 cases of brain stem injury, 4 cases of cerebrospinal fluid leakage and 5 cases of intracranial infection. The average preoperative Karnofsky performance status (KPS) score was 73.6±8.7. The average KPS score at 6 months after operation was 79.7±8.8. The average KPS score at 6 months after operation was better than that pre-operation (P<0.05). For different approaches, the intraoperative blood loss in the infratemporal group was more than that in the retrosigmoid group (P<0.05), and the total resection rate was higher than that in the retrosigmoid group (P<0.05).

Conclusion

Most of petroclival meningiomas are benign tumors. Most of petroclival meningiomas can be totally or subtotally removed by careful microsurgery. Although the intraoperative blood loss of infratemporal approach was more than that of retrosigmoid approach, the total resection rate was higher.

Key words: Petroclival region, Meningioma, Microsurgery, Clinical efficacy
图1 岩斜区脑膜瘤经颞下Kawase入路切除患者术前、术后MRI影像A~C：术前MRI示岩斜区脑膜瘤（A：轴位；B：冠状位；C：矢状位）；D~F：术后复查MRI示肿瘤全切（D：轴位；E：冠状位；F：矢状位）
表1 颞下组与乙状窦后组患者基本资料及手术效果对比
资料 颞下组（n=35） 乙状窦后组（n=27） χ2/t值 P值
性别（男/女） 7/28 6/21 0.045 0.831
年龄（岁，Mean±SD） 52.5±11.7 51.8±11.2 0.238 0.813
肿瘤直径（cm，Mean±SD） 3.3±1.2 3.2±1.1 0.227 0.822
手术时间（min，Mean±SD） 474.3±136.2 443.3±151.7 0.871 0.387
术中出血量（mL，Mean±SD） 454.3±202.3 277.8±115.5 4.048 <0.010
肿瘤全切[例（%）] 25（71.4） 12（44.4） 4.612 0.032
脑脊液漏[例（%）] 3（8.6） 0（0） 2.432 0.119
颅内感染[例（%）] 3（8.6） 1（3.7） 0.598 0.439
颅神经受损[例（%）] 13（37.1） 9（33.3） 0.097 0.756
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