摘要
目的分析岩斜区脑膜瘤影像学分型及手术入路选择。方法回顾分析318例岩斜区脑膜瘤临床资料，将其分为岩尖型、海绵窦型、蝶岩型、岩斜型、岩斜海绵窦型、CPA型、斜坡型和广泛型，根据分型选择手术入路。结果入组248例，术前KPS评分73．7±10．3。主要入路包括乙状窦前入路（49．6％），颞下经岩经小脑幕入路／岩前Kawase入路（STrA／KA）（35．1％）。全切（SimpsonI、Ⅱ级）52．4％。前3型主要入路为STrA／KA（53．7％），而后5型则为乙状窦前入路（63．8％），差异有统计学意义（x2=27．461，P〈0．001）。乙状窦前入路的第Ⅵ、Ⅶ和Ⅷ脑神经并发症率较STrA／KA高。随访KPS评分为75．8±26．9，较术前差异无统计学意义（t=-1．321，P=0．188），改善57．7％，稳定19．0％。结论岩斜脑膜瘤分型有利于手术入路的选择，STFA／KA入路适于前3型，而乙状窦前入路则适于后5型，但仍需术前全面评估，实现个体化治疗，以达到最佳预后。
Objective To analyze the classification of petroclival meningiomas according to the tumor extension on magnetic resonance imaging （MRI） and choice of surgical approach. Methods The clinical data of 318 cases of petroclival meningiomas were retrospectively analyzed. The cases were classified into eight types ： petrous apex, cavernous sinus, sphenopetrosal, petroclival, petroclival - cavernous sinus, cerebellopontine angle （CPA） , clival and extensive types. The pre - and post - operative statuses were evaluated by Karnofsky Performance Scale （KPS）. Results 248 patients were included in the study with a mean preoperative KPS of 73. 7 ± 10. 3. The most frequent approaches were presigmoid transpetrosal approach （49.6%） followed with subtemporal transpetrosal and transtentorial approach/Kawase＇ s approach （STFA/KA） （ 35. 1% ）. Complete resection （ Simpson Grade I or II ） was achieved in 52.4% patients. The most frequent approach of the first three types was STYA/KA （53.7%） and presigmoid transpetrosal approach （63.8%） in the latter five types, and the different proportion of approaches used between the two groups was significant （X2 = 27. 461 ,P 〈 0. 001 ）. The complication rate of cranial nerves VI, Ⅶ and Ⅷ of presigrnoid transpetrosal approach was higher than that of STTA/KA. The recent KPS was 75.8 ± 26.9 without statistical difference from preoperative KPS （ t = - 1. 321, P = 0. 188 ）. Compared with preoperative status, 57. 7% patients were improved and 19.0% were stabilized at recent evaluation. Conclusions Classification of petroclival meningiomas will contribute to the approach selection. STFA/KA approach is fit for the first three types, meanwhile, presigmoid transpetrosal approach is suitable for the latter five types. Comprehensive preoperative evaluation is essential to achieve individualized treatment and favorable prognosis.
出处
《中华神经外科杂志》
CSCD
北大核心
2012年第8期783-787,共5页
Chinese Journal of Neurosurgery
基金
基金项目：首都医学发展基金（2009-1040）
卫生部卫生公益性行业科研专项项目（200902004）
国家自然科学基金项目（81141028）
关键词
脑膜瘤
岩斜区
乙状窦前入路
颞下入路
分型
Meningioma
Petroclival
Presigmoid approach
Subtemporal approach
Classification
