CAJ | 학술논문

目的探讨侵入海绵窦的岩斜脑膜瘤的临床特点、手术策略、手术技巧和治疗效果.方法　回顾性分析2004年4月至2009年3月南昌大学第一附属医院临床资料完整的15例侵入海绵窦的岩斜脑膜瘤病例,总结其临床特点.本组均采用经乙状窦前入路,手术策略为全切除岩斜区肿瘤,对侵入海绵窦内的肿瘤行次全切除,术后辅以γ刀治疗.分析手术后颅神经功能和病人生存状况.结果头痛头晕、外展麻痹和面部麻木为本病的主要症状.手术近全切除肿瘤13例,切除≥90%2例.12例残余肿瘤术后行γ刀治疗.无手术死亡,术后无新增颅神经损害6例,出现动眼神经麻痹6例,面部麻木7例,外展功能障碍4例,面瘫7例.随访6～59个月(平均38.6个月),12例恢复正常工作和生活,2例生活自理,1例生活需他人照顾.13例无肿瘤复发,2例残余肿瘤增大者中1例经γ刀治疗肿瘤生长得到控制.眼球运动和上睑下垂均完全恢复,面瘫基本恢复,面部麻木5例部分缓解,外展功能障碍无明显改善.结论对侵人海绵窦的岩斜脑膜瘤应采用合理的手术策略,尽可能减少手术引起的神经损害,有利于提高病人的生存质量.
목적 탐토침입해면두적암사뇌막류적림상특점、수술책략、수술기교화치료효과.방법　회고성분석2004년4월지2009년3월남창대학제일부속의원림상자료완정적15례침입해면두적암사뇌막류병례,총결기림상특점.본조균채용경을상두전입로,수술책략위전절제암사구종류,대침입해면두내적종류행차전절제,술후보이γ도치료.분석수술후로신경공능화병인생존상황.결과두통두훈、외전마비화면부마목위본병적주요증상.수술근전절제종류13례,절제≥90%2례.12례잔여종류술후행γ도치료.무수술사망,술후무신증로신경손해6례,출현동안신경마비6례,면부마목7례,외전공능장애4례,면탄7례.수방6～59개월(평균38.6개월),12례회복정상공작화생활,2례생활자리,1례생활수타인조고.13례무종류복발,2례잔여종류증대자중1례경γ도치료종류생장득도공제.안구운동화상검하수균완전회복,면탄기본회복,면부마목5례부분완해,외전공능장애무명현개선.결론대침인해면두적암사뇌막류응채용합리적수술책략,진가능감소수술인기적신경손해,유리우제고병인적생존질량.
Objective To analyze the clinical features, surgical strategy and management outcomes of petroclival meningioma invading into cavernous sinus. Methods Fifteen cases with petroclival meningioma invading into cavernous sinus were retrospectively analyzed. The presigmoidal approach was selected to remove tumors. The surgical strategy for tumor in cavernous sinus was partial resection combined with radiosurgery. Postoperative cranial nerve function and patient survival status were analyzed. Results The main symptoms of subtype of petroclival meningiomas were headache, abducens nerve palsy and trigeminal neuropathy. Gross total tumor removal was achieved in 13 cases and more than 90% resection in 2 cases. There was no operative death. Nine cases suffered from new postoperative cranial nerve deficits. After a follow-up of 6-59 months, complete improvement was achieved in oculomotor nerve deficits, much improvement in Ⅶ nerve deficit, but Ⅴ and Ⅵ nerve function deficits improved slightly. The tumor progression-free survival rate was 86.7%. Conclusion Rational surgical strategy to petroclival meningiomas invading into cavernous sinus should be suggested to reduce the operative morbidity and improve the survival quality of these patients.